It's a dedicated bare metal machine for you. The tradeoff with Hetzner is, that it's not expensive Server hardware, so you will encounter hardware problems more often compared to a Dell or HP server.
If you mean that you can have a load balancer in front of it managed by Amazon, that's true for dedicated as well (Akamai, CDNetworks, Limelight, even Leaseweb). Managed databases are available from most providers (usually without an API, but you can find them with an API as well).
I've had one server with them for about 3 years, and another for 2 years, and haven't run into a hardware issue yet. Obviously a hardware issue could happen at any time, so anything I can't live with being offline until I can restore from a backup is configured with redundancies, including a Digital Ocean VPS just in case the datacenter my servers are in goes offline.
From my monitoring, however, I tend to see a short network blip about every other month, but it's less than a minute at a time. All other outages I've had were my own fault.