Wednesday, August 19, 2009

Health Care in Germany--My Experiences

As an expat living in Germany, I get asked by friends and relatives to explain the health system here. I cannot back my experiences up with statistics, and I don't know if I am typical, but will try to detail some of my dealings with the German medical apparatus.
First some background: I have lived here for over 25 years and --by necessity-- have become fluent in the language. This gives me an advantage over other foreign workers who may not be able to express themselves adequately (this is a big problem among the Turkish population, who often never learn the language). However, my written German is not error-free, so I will usually get someone to check my grammar if I have to write an official letter.
My children were born here, so my first dealings with the system were to do with maternity issues. My wife began to have premature labor pains in the second trimester, and so it was recommended that she be medicated. She was given a room in the hospital and stayed there for 5 weeks. By which time she was so excrutiatingly bored that she decided to come home. The hospital stay didn't cost us anything.
When she went into labor, we just drove to the nearest hospital. There was a midwife on duty, and a doctor. The midwife was experienced and skilled, the doctor was a young woman probably only a couple of years out of medical school. It was funny to watch, because the doctor would make some suggestion and the midwife would say, "Nonsense!" and go back to chatting with me about opera.I was encouraged to stay for the birth.
The birth went without complications, and after delivery, they gave my wife a glass of champagne and took her back to her room while the baby was examined.
They stayed in the hospital for about a week, which seems to be a normal length of time. No charges for anything.
My boys have been pretty healthy, but we have used the system for dental work (fillings are free; crowns depend on what kind of material you want-- the silver ones cost nothing, but they charge for ceramic); one boy had a hernia operation, the other had some asthma. No charges, either for the examinations or the operation, and the medicines have only a nominal charge.
A couple of years ago, I had a pinched nerve in my neck. The doctor recommended having it operated on because it was affecting my playing. I could have had the operation locally but decided to have it done in Heidelberg at a private clinic because it could be done a week later, whereas at the local hospital I would have had to have waited a couple of months. The operation, which I then paid myself, cost roughly $5000, but that included all the fees and hospital stay; and I could deduct the cost from my income taxes.

The cost of health insurance here is based on your income. This means that the higher income brackets subsidize the lower ones. I could have joined a "private" scheme, which is slightly cheaper and gives you access to a greater range of specialists, but I made the conscious decision to stay with the "public" insurance because I find it such an improvement over the American system-- I don't mind paying a bit more to show my support for the scheme.

In Germany, there is far less reliance on medicines, except of course for chronic diseases. I have never heard of anyone (for example) getting drugs for ADD, and the use of tranquilizers is extremely rare. (Maybe it helps that many people have a beer at lunch?) I am always amazed at the array of drugs I find in people's bathrooms in America.

Why is it then that in America so much more money flows into the heath system, but the benefits are nowhere to be seen? Here are some statistics:

Looking at the World Health Organization’s Core Health Indicators, Germany has better numbers than the US in most health care related statistics. Here are some highlights:
Life expectancy at birth, for both sexes combined, is 80 years in Germany and 78 in the US
Healthy life expectancy at birth, for both sexes combined, is 72 years in Germany, 69 years in the US
Infant mortality rate (per 1000 births) for Germany is 4.0, the US is 7.0
Hospital beds (per 10000 people) is 83 in Germany and 32 in the US
Physician density (per 10000 people) is 34 in Germany and 26 in the US
Total expenditure on health as percentage of GDP for Germany is 10.7%, the US is 15.2%
and Per capita expenditure on health is $3250 in Germany and $6350 in the US

My feeling (no statistics to back this up, this is just a theory) is that in America, because the cost of medical care is so high, and so many medicines are available in supermarkets (here even asperin has to be purchased from a licensed pharmacy) that people tend to overuse drugs and invent their own prescriptions, leaving the underlying problems untreated until they are in a much worse condition.
Added to this is the pervasive medical litigation, which drives malpractice insurance costs very high for workers in the health professions. Germany's legal system precludes working for contingency fees and class action suits. Legal fees are strictly regulated and are required to have some relation to the amounts involved in the case.
So what disadvantages does the German system have?
In hospital, unless you pay an extra fee, you will be sharing a room with 2 or 3 other people.
Extra or unusual treatments will generally not be covered.
Cosmetic surgery is not covered unless your doctor can convince the insurer that it is really necessary.
Lawyers are not generally filthy rich.
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