Morbidity and Mortality of Statutory Versus Private Health Insurance Patients in Cardiac Surgery in Germany and a Critical Appraisal of the Current Health Insurance Situation

Background: In all, 90% of patients in Germany are insured with statutory (SHI) instead of private health insurance (PHI). PHI offers significantly better benefits including earlier and more comprehensive diagnosis and therapy, which can reduce the complication rate and even mortality in fields where patients with high morbidity are treated, yet data on potential outcome differences between SHI and PHI patients in Germany is scarce. Methods: Between January 2023 and December 2025, 144 PHI and 2094 SHI patients underwent heart surgery at one institution. Preoperative baseline characteristics, risk factors, and peri- and postoperative information, including the surgeon’s experience level and distance of the referring hospital, were retrospectively compared. In addition, a propensity score matching (PSM) analysis was performed. Results: The SHI group presented with significantly higher BMI and EuroSCORE II, fewer male patients and higher NYHA states. Significantly more PHI patients were operated on by very senior staff members and none by a trainee, and their hospitalization time was significantly shorter. Neither early mortality (PHI 3.47%, SHI 5.35%, p = 0.432) nor distance levels of referring hospitals differed significantly. After PSM, only differences in the hospitalization time and surgical experience level remained significant. Early mortality came down to 4.86% in the SHI patients after PSM. Conclusions: In a multimorbid patient group, we found no evidence for a difference in outcome depending on insurance status, aside from a shorter hospital stay for PHI patients. Nonetheless, the situation in the pre- and post-hospital phases for SHI patients may have room for improvement. Efforts should be made to give all patients the same rapid and comprehensive access to healthcare services, increasing the system satisfaction of patients with SHI. In cardiac surgery, fortunately, there is no particular need for adjustments regarding the in-hospital phase.