What Germany gives you free, and what the €1,900 check adds

Germany already runs a national preventive health programme. It is called Check-up 35, it is free to every statutory insuree, and almost nobody selling private screening will tell you what is in it.

The omission is commercially rational and analytically fatal. You cannot judge whether a €1,900 programme is worth €1,900 without knowing what the €0 programme already does.

The statutory baseline

From age 35, statutory insurees are entitled to a health check every three years.1 Those between 18 and 34 get one, once. Several Kassen fund more than the minimum as a voluntary extra, which is worth asking about because the answer varies by fund.3

The check contains a whole-body physical examination, blood pressure, fasting blood glucose, total cholesterol with LDL, HDL and triglycerides, urinalysis, a one-off hepatitis B and C screen, and a structured consultation.2 Its declared targets are cardiovascular disease, kidney disease and diabetes.4

Judged against those targets it is a sensible instrument. Blood pressure, lipids and fasting glucose are three of the cheapest high-yield measurements in medicine, and the consultation is where smoking, alcohol and family history are supposed to surface.

What it leaves out

No imaging of any kind. No tumour markers. No genetics. No functional testing, so no VO₂ max, no DEXA, no cardiopulmonary exercise test. No hormone panel. No inflammatory markers beyond what the lipid panel implies. No microbiome. No continuous glucose monitoring. No liquid biopsy.

Age- and sex-specific cancer screening sits outside Check-up 35 in separate statutory programmes covering mammography, cervical screening, colonoscopy, skin cancer screening and prostate examination, each with its own eligibility rules.

The important thing about that list is that most of it reflects a decision rather than an oversight. German screening guidelines exclude population-wide whole-body imaging and untargeted tumour marker testing because the assessed harms exceed the assessed benefits at population scale. You can argue with that assessment, and the pace of guideline revision is a fair target for criticism. It remains a clinical judgement about net benefit rather than a queue.

Where private programmes actually sit

Once the baseline is explicit, the private market resolves into something clearer than its marketing suggests. Nobody is selling you a health check. They are selling an increment on top of one you already have, and the increments differ enormously.

Neko Health, at £299 in the UK, sells roughly the statutory panel plus a full-body optical skin scan and a cardiovascular sensor array, packaged into an hour with an interface people enjoy. The medical increment over Check-up 35 is real but narrow. The behavioural increment may matter more: people turn up, annually, because the experience is pleasant, and attendance is the part population screening usually fails at.

Preventicum in Essen, one of the older German private check-up centres, sits at a reported €1,400 to €2,000 for packages built on internal examination, laboratory diagnostics, 4D ultrasound and rest and stress ECG, with MRI of two organs where clinically indicated.5 Organ-targeted imaging rather than whole-body imaging is a defensible position on the evidence and a narrower one commercially.

YEARS, in Berlin, makes the opposite bet, and its entry tier is more interesting than the headline range suggests. Core is €1,900 for six hours and buys 87 biomarkers plus spiroergometry, echocardiography, vascular ultrasound, a cognition test, lung function testing and a body composition scan, with a physician review. It contains no imaging, no liquid biopsy and no genetics, and the company states this in those words. Whole-body MRI and a multi-cancer liquid biopsy arrive at Evolve, €7,600. Genome sequencing, epigenetic clocks and microbiome analysis arrive at Ultimate, €16,900.6

Set the €1,900 tier against Check-up 35 and the increment is specific rather than sprawling: the same cheap cardiovascular and metabolic basics, plus the functional testing the statutory system does not fund at all. Spiroergometry is the significant addition, because cardiorespiratory fitness carries stronger mortality evidence than anything in the statutory panel. That is a defensible thing to sell somebody for €1,900, and considerably more defensible than an unproven scan at the same price would be.

The comparison worth making

The pattern applies to every provider in the market. The question is never whether the private check beats nothing. It is whether the specific additions justify the specific price, given that the cheap high-yield measurements are already free.

Book the free one first. On a cost-per-decision basis it is the highest-value preventive appointment available in Germany, and a meaningful share of people buying €7,600 programmes have never used their statutory entitlement.

Then, if you want more, buy more with the baseline in hand. A private programme reading your lipids for the first time is doing work that was already available to you. A private programme reading your lipids next to an ergospirometry result, a coronary assessment and a whole-body image is doing something the statutory system does not attempt. Only one of those is worth paying for.