German Health Care through my Window

I might have mentioned before that I grew up in Germany.  I live german style.

One way of german life is to always have health insurance. I left my parents insurance when I became a student and immediately signed up to a german “public” insurance. I walked into the nearest office, showed them a passport and my student documentation and walked out signed up to a cheap student rate within an hour. Nobody asked me about any history of illnesses in the family or my own. If I ever wanted to change my insurance now, the fact that I had two caesarians would be irrelevant and my payable rate would be based on my income and not my current health status or age or likelyhood of illnesses as long as I stick with a public option, of which we have several to pick from.

Whenever I go to a doctor I show him my card, they pick up my details from the chip on it and I never see a bill or have to worry about the expense. Small charges on medicines or doctors visits for adults might occur, but we are talking in the range of 10 or 15 Euros.  Something negligible, when compared to paying the full price, yet something the public has accepted only grudgingly and is hoping will not last. This summer the monthly fee for our insurance actually went down, so savings the insurances make are passed on to us.

Over the years the insurances have developed many programs and incentives to improve the health of their insured and reward those clients that go for regular check ups by reducing the fee. Overall being healthier and catching illness early on can bring down the cost for healthcare, benefiting all, because this money can be used for other health issues.

While following the recent health debate in the USA I came across the excitement about end of life discussions. I asked a friend if we had similar provisions and where I could sign up for such a program. It turned out she had done it herself. All it meant is that she talked to her doctor about her own personal choices, put them in writing (a document with helpful questions is available) and left a copy with her doctor and children. She wanted to have control over what happened to her in a moment when she might not be responsive and at the same time be able to spare her loved ones the additional anguish of having to second guess her wishes.

This is, she does have a private insurance and they offer many of the features a public health insurance offers, except that they will charge a little more for pretty much everything more than basic. So if you are not younger than 30, healthy and male, expect to pay more and as you grow older, more and more and more. Surprise! It is private after all and they care more about the money than you. Private Insurances are a thriving business in Germany, because there are so many, many things you need insurance for (your car, your house, your trips, your tendency to break other peoples things – PLENTY – they don´t need health insurance to do well and drive around with fancy cars, which I paid for…. Grunt!).

I was able to take advantage of the social side of the system when I was temporarily unemployed. My insurance offered a reduced rate. This arrangement was  available for a limited amount of time. It ensured though that I was still paying into the system, while staying healthy and once I had a full time job again, my premiums automatically were adjusted to my earnings. They stood by me and I am a faithful client since 30 years.

Another very pleasant part are the regular check ups you are expected to make for your children. Until they are teenagers you are encouraged to bring them in at specified intervals to evaluate their development, catch problems early on or simply provide peace of mind. These visits are always voluntary, but many parents subscribe to the idea that better one doctors visit too many than one too few. (See Truegermans blog entry last week –  children are insured for free in the public option)

I know the system is not perfect. My personal grudge is that they are peevish about including homeopathic treatments. But a lobby of patients exists and people are making their opinions and positive experiences known to the insurers, so progress has been made and more will be made, if slowly. We could have single payer, but I´ll take this one in the meantime and enjoy that system when I am in England.

It is believed that a percentage of 0,25 of the population have no insurance due to varying reasons. But “Germany” believes that leaving them to their own devices creates more problems than if solutions were found to integrate this last pocket of insuranceless individuals. Since last year it has become obligatory to be insured and if you should have lost insurance due to extremely hard times the government is forcing insurers to provide affordable rates. Should you be uninsured because you were avoiding to contribute to the pot and expect the rest of us to pick up the tab and pay it from that said pot, well those days are over.

5 Million of the 85% of the population could choose to switch to a private insurance, as they are wealthy enough, to afford paying their own way. But they stay in the public option, although they would be paying cheaper monthly premiums for each individual (No children included. They need their own insurance). Why? Maybe, like me, they were not always that well off and their insurance stood by them. They didn´t forget.

And I have always felt safe. I never wondered if myself or my children should fall sick, if I would be able to afford treatment. I have never had to pay a bill up front, as they go straight to the insurer, saving everybody time and bureaucratic messes, providing myself a lot of peace of mind.

A worry, a big worry less, which is good for my mental health.

For the rest I hope just to keel over on my keyboard one day.

@Francesca

Useful Links:

http://de.wikipedia.org/wiki/Gesetzliche_Krankenversicherung

Versichertenstruktur

Etwa 85 Prozent der Bevölkerung in Deutschland sind bei einer der gesetzlichen Krankenkassen versichert.

Versicherte der gesetzlichen Krankenversicherung in Deutschland. Stand 1. Juli 2006

http://www.g-k-v.de/gkv/  Information in German about public option

For your Info: Once you have chosen a private option it is not so easy to switch back to a public option. A lot of foreigners coming here, thinking they will stay for only one year, decide for the cheaper private option. Ten years later, married and with kids and still in Germany, they wish they had thought long term. Some friends this happened to swear as well that the private insurer never mentioned they could not switch back so easily, au contraire.

 

NO I am not advertising for these guys, but they were the only ones that have a really good english page on german health insurance (they do have a very good reputation though  – so I feel confident their info will be reliable):

http://www.tk-online.de/tk/tk/english/the-right-choice/156480

Here´s a story that makes me think our system ain´t half bad:

http://www.themudflats.net/2009/09/20/welcome-to-the-death-panel/

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7 Comments

Filed under Germany

7 responses to “German Health Care through my Window

  1. If I’d been a little younger when I came to Germany, I’d have opted for the private insurance. My wife is on a private plan and gets treated like royalty. She gets to jump the queue for everything, has virtually everything covered including all dental, for less than I pay – and she makes more than I do.

    And when they raise the ceiling for the maximum contributions – this is just a matter of time, probably after the election – then we’re going to get massively hosed.

    • Hi Ian,
      thankyou for your comment. The issue of private or statutory health insurance is quite complex. I can only state what my experience and those of my friends have been, of whom many chose the public option after a lot of consideration, despite its imperfections and how my experiences tally with the figures. To cover all aspects goes way beyond the scope of this blog and I cannot possible give room here to all the points which have to be balanced.

      I´m sorry if you feel that you are being ripped off. Sometimes I do too. On the other hand I live a very comfortable life in this country, where most people have insurance, be it private or public and can afford it. No insurance can tell you you cannot have an insurance due to a pre-existing condition or drop you when they find out you are a victim of domestic violence as happens in the States.

      I wonder though, why you say you would have chosen private if you had been younger when you arrived here. Why not switch now?

      My experience is that “we” tend to nag and forget the advantages over the disadvantages. Hope you agree.

      Have a great week-end

  2. Sirenoftitan

    Thanks for the insight into the German health care system.

    • Hi Siren, you are welcome. It is quite interesting and I am not finished learning. There are a lot of open questions. But mostly the sentiment and experience with public insurance is positive. I wish I understood the english system better. If you have any useful links I´d be appreciative. Maybe you can post them at Mudflats?

  3. pj

    Just having options sounds so great to me, I’m what they term “uninsurable” because of luekemia. But no insurer will say that and no employer will keep me long once they are informed premiums for them and every other employee will be raised. But what the hell, if you don’t speak a thing that thing doensn’t exist, right?
    As a U.S. citizen that is only 2nd generation of German grandparents can I move? Silly question, sorry, just frustrated. I would never leave; for all our troubles.
    Thank you for sharing your experiences. I hope some of our lawmakers will consider the German model when constructing a “HealthCare Reform” bill.
    Or is that too socialist? 🙂

    • Hi Dear PJ, as I say everybody I know is insured in Germany. It´s not considered a bad thing to be a socialist when it comes to the social net (sozialnetz) that Germany has woven to prevent an individual from being lost to society by unfortunate circumstances. It is considered unfair that somebody that has been working should not be able to accumulate some credit in society, that he can use if he should fall sick. One case I am thinking of involves a man who became sick due to the work environment. He doesn´t have the means to prove it, but would it be fair to dump him by the wayside? And what happens to his kids? Or would you rather he just jump off a bridge and his kids would be abandoned to themselves? No way, you make sure that after a life time of work he is taken care of, his kids can go to school and can start careers and someday they pay back into the system with their taxes and with their contributionsI to health care. It might be socialist, but does that make it wrong? I think it is part of our better human nature.
      It´s a scandal that you are kept out of work by the system in place. That is wrong and undignified behaviour for a country of the stature of the US.

  4. I don’t feel I’m being ripped off, I just recognise the reality of things. If you’re on a private plan, you get treated well. Public, take a number.

    Switching to a private plan is no longer an option for me. The older you get, the more they charge you to start and it rises from there. Also, with a pre-existing condition the private insurers won’t touch you with a bargepole, so that rules me out.

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