Tag Archives: health insurance

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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On health insurance and bicycles

We wanted to write about cycling. Now I see the head of Francesca´s post — obviously she wants to write about health insurance.

Hmmm.

I know there was thunder and lightening in the US about Barack Obamas proposals for a new health insurance system. When we last met, Francesca got excited, too. I couldn´t. Health insurance isn´t an issue, it is a fact.

Everybody in Germany is insured, from the first to the last day of his or her life. Everybody in need is cared for. My health insurance covers medical treatment in all of Europe. I show my card, the doctor accepts it, my treatments are paid, that´s it. If I earn a lot of money, I pay more; if I earn less money, I pay less. Children and spouses without income are covered by my insurance as well.

If I earn enough money to be able to advance the medical bills before  my insurance company reimburses the bill, I´m allowed to go private. But I can decide to stay with the public system as well. In this system, my insurance rate depends only on the amount of money I earn, not on the money the insurance company spends on my medical bills. When I´m young I pay more than I cost the insurance. When I´m old I kind of get this money back, because then the medical costs are higher while the insurance rates still stay the same. There are several insurance companies in the public health system I can choose from. Each of them has a slightly different profile. But all of them have to stand by me when when I´m ill. They can´t end the contract the moment I need health insurance. They can pick me, but they can´t leave me. One of them even has to take anybody who pays the rates – no questions asked.

Pretty simple, isn´t it?

My duty done,  I can proceed to the joy of cycling.

Though this turns out to be an health issue, too. Cycling burns fat, kills stress and strenghtens the immune system.

Cycling is a natural part of German life. You will find at least one bicycle in 80 percent of the German households–there are more households with a bike than with a car!  On average, there are 1,8 bicycles in a household. Family with kids always have bicycles. Chances are fifty-fifty that their over-80 year old grandparents own a bicycle, too.

So, bicycles are omnipresent, though they are not always present. In my lifetime, from when I learnt cycling at the age of 7, I have owned and lost a lot of bicycles. Most of them were stolen. Each year, roughly 400 000 bikes are stolen in Germany, ten times as much as cars. Especially in cities like Frankfurt chances are high that you loose a good bike within a year. Therefore, city-dwellers often have two bikes: an old, dull, undesirable  working-bicycle for Monday to Friday,  that can be left outside like a horse in front of a saloon, and a sparkling sleek machine for the weekend, which is kept protected in cellars specially designed for bicycles.

To ride a bike to work is common practice in Germany, at least in the cities. It takes less time to go by bike than by car or by public transport. These bikes are practical: wide tires so you don´t get stuck in the tramway rails, a sturdy carrier for the laptop case or the shopping bag, a mudguard so you don´t end up with a strip of dirt on your shirt on a rainy day.

If these bicycles equal marriage, weekend bikes are love affairs. There is no end to how much a bicycle may cost. Though, as in extramarital affairs, men are the main actors here. Women can resist the temptation of superefficent brakes, superlight frames and superhigh gears. Men can´t.

This said, I must confess that I can´t, either. Though I don´t look the type. I learned this the hard way when, one Saturday morning, the whole family set out to get new bicycles: first my husband, then my son, then me. While the men discussed the merits of this Shimano gear system over that Shimano gear system, I strolled through the shop and found my bike.

“Which bike would you like?”, the salesman adressed me, having to leave a highly satisfying talk of experts for the mundane task of  earning some more money.

“I would like this one”,  I said.

“This one?” he cried in disbelief, as his expression of professional friendliness changed to incredulous surprise.

“Yes, this one. Is there anything wrong with the bike?” I inquired. “Can´t you recommend it?”

“It´s good. But … women  like you .. never ask for this bike.”

Maybe my black racing bike with dropped handlebars equals the red sports car middleaged men buy after their 45th birthday. It certainly offers open-top riding. But where is the blonde 20something to go with it?

@Truegerman

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