Up until now Germany's once generous welfare state provided the country with largely comprehensive healthcare services, including spa treatments and taxi bills paid by insurers. But health premiums have jumped from 11 percent of gross salary in 1977 to more than 14 percent today with only the Swiss and the Americans paying more than the Germans for healthcare.

Key points of the new healthcare system Medical surcharge: In future general patients will be required to make a payment of EUR 5 or, at the most, EUR 10 on any medial care they receive. Hospital care will cost EUR 10 a day for a maximum of 28 days per year. Those receiving out-patient care and house visits will face an additional charge of EUR 10 plus 10 percent of the overall medical bill. Sick pay: From 2006 employers will be required to pay all salaries for workers after the seventh week of sick leave without receiving any assistance from the insurance companies. Workers will be required to pay a supplementary premium of 0.5 percent. Sick pay up to the sixth week of illness is covered by health insurance. Cuts in claims: Patients will no longer be able to make health insurance claims for taxi rides to out-patient treatment. Claims for sterilisation for non-medical related reasons has also been removed with financial for spectacles and other sight aids only available for patients under 18 years and for the severely handicapped. Death benefits and cash payments when a new baby is born are to be dropped. Non-prescription drugs and so-called “lifestyle” drugs will no longer be covered by the funds. Preventive action: Patients who undertake preventive care will be rewarded with a rebate by health funds. Out-patient treatment within the EU will be covered, but for a hospital stay approval from the insurer is required. Pharmacy revolution: Pharmacies are also been revamped. Mail order pharmacies are now permitted and chemist shops can operate chains of up to three branches. Dental care: Dental prostheses such as crowns, bridges and dentures will not be covered from 2005 and patients will be required to take out separate insurance.

The aim of the new reformed German health service to share the pain of reform with Germans forced to pay more out of their own pockets for medical care. However, critics of the reforms say that they will fail to adequately wind back the contributions made by workers and employers to the health service and that additional big changes will be needed in the coming years to stem the costs of the system as the German population ages. As a sign that the German health reform debate still has some way to go, there have now been calls for the introduction of a so-called citizen insurance scheme which could require every citizen to make contributions to the nation's hard-pressed public health insurance groups. This includes many public sector employees and the self-employed who are at present are able to take out private health cover. Private health insurance is also popular with expats living in Germany for a specific period. If you want to follow the private health insurance route it pays to shop around before settling on a fund as many offer policies and benefits that are tailored to people living in the country for a limited period. All students in Germany are required to have health insurance. This means that you will have to provide proof of your health insurance cover in Germany before you can register at a university or college. In general those working for German companies will find that their employers arrange their health insurance cover. Employers and employees each pay half of a member's premiums, which is at present is 14.3 percent of an employee’s income. But from 2004, this will be reduced next year to 13.6 percent and in 2006 to 12.15 percent. Arranging health insurance often means that you also have to organise yourself a doctor. Embassies and councils sometimes have lists of English-speaking doctors and dentists, but if language is not a problem one way of finding a doctor (Hausartz) is to ask your local pharmacist if they could recommend a doctor in the neighbour. This also goes for both dentists and specialists. Many doctors in Germany offer both conventional medicine and alternative forms of treatment such as homeopathy and you maybe asked which treatment you prefer. If you have any major dental work to be done you should first ask your dentist for a quote and then check it out with your insurer. All surgeries will have set hours for visiting (Sprechstunden). For those who are members of public health funds you simply turn up during the allotted times and present your insurance cards. Privately insured patients should ring in advance as in most cases they will be given a special appointment and be able to jump the (often) long queue in the waiting room. Although in some very busy big city general practices this does not apply. You can go straight to a specialist in Germany, but sometimes it is better to first see your GP first as they normally have a stable of specialists they work with. Either way, you should always take your health insurance card with you, including if you have to go the hospital. Payment using credit cards for medical services is very rare in Germany. In general, doctors' bills are sent to your home address and paid via your bank account. You must keep a copy of all bills (both visits to the doctors and prescriptions) for sending on to your health insurer. Pharmacies tend to follow the old-fashioned Germany trading hours and are open between about 9am and 6pm. A list of showing late-night openings of pharmacies in your neighbourhood is normally in the front window of your local chemist. Chemists in areas such as airports, busy shopping centres and railway or underground stations are often open until at least 8pm. Subject: Living in Germany