Germany's healthcare system has undergone some major surgery and the signs are that the operation has been a success. But what will this mean to health service users?

• key points of the healthcare system

Many doctors offer both conventional medicine and alternative forms of treatment

Angry weekly protests have come to symbolise the opposition and fury created in parts of Germany to Chancellor Gerhard Schroeder's tough economic reform agenda. But Schroeder can claim one major success from his overhaul of the nation's welfare system with evidence that the changes to the country's lumbering health service are starting to work.

Several of the country's big public health funds have said they plan to start lowering premiums following the publication of official data showing that the funds had chalked up a surplus totalling EUR 2.5 billion in the first half of 2004. After posting a deficit of EUR 805.6 million in 2003, AOK, one of the country's biggest statutory funds with 19 million members, reported a first-half surplus of EUR 960 million in 2004.

"It is clear that the health reform is working," declared Health Minister Ulla Schmidt. "All the big insurance funds said they would have had to raise funds without it." 

The improvement in the health funds' finances follows the introduction in January 2004 of the government's deeply unpopular health service reforms, which included a special quarterly EUR 10 charge for patients visiting doctors and higher fees for patients on drugs.     

Since then, the health funds reported that costs for drugs, sick pay and patients' travel expenses dropped in some cases by double-digit amounts.

The fall in costs reflect key elements of the government's reform which include restrictions on travel expenses, coverage of sick pay, and the introduction of higher deductibles on prescription drugs and abolition of coverage of over-the-counter drug sales.  

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 with only the Swiss and the Americans paying more than the Germans for healthcare.

The aim of the new reformed German health service is to share the pain of reform with Germans forced to pay more out of their own pockets for medical care and the government hoping that the lower premiums will help to spur private consumption in the nation.

However, critics of the reforms say 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, a debate is still underway as to whether people will be required to purchase additional insurance for some dental work such as bridges, crowns and replacement teeth.  

The government has also been considering the introduction of a so-called citizen insurance scheme which could require every citizen to make contributions to the nation's 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.

Health Minister Ulla Schmidt claims health reform is working

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.

Since the start of 2004 premiums have dropped to average of 14.2 percent of an employee’s income. This will be reduced next year to 13.6 percent and in 2006 to 12.15 percent.

The changes underway in the German health service have also included health funds launching so-called bonus programs where people are encouraged to take preventive action against medical problems.

Some health funds have even considered to steps to cover the Praxisgebühr (the charge for visiting doctors).  Privately insured patients are not required to pay the Praxisgebühr.  

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. In addition, many health funds have rules for payment for specialist services.

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.

KEY POINTS OF THE HEALTHCARE SYSTEM Medical surcharge: Patients insured with statutory funds will be required to make a quarterly payment of EUR 10 when they visit a doctor. Private patients are exempt. Hospital care: This costs 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. Dental care: As things stand at the moment patients needing dental prostheses such as crowns, bridges and dentures will not be covered from 2005 and patients will be required to take out separate insurance. But a political debate is underway raising questions whether this will eventuate.

September 2004

[Copyright Expatica 2004]

Subject: Germany health, healthcare reforms