Healthcare in Germany

My patron Hauke suggested that I spend a video
talking about healthcare in Germany. Which, to me, didn’t sound like the kind of thing
you’d want to listen to for four or five minutes. But actually, there are some
important things to say about it. German health insurance goes back to the year 1883 and Chancellor Otto von Bismarck — you know, the hardline, strict, authoritarian,
warmongering politician who united most German-speaking territories
into a single nation state. He created a system whereby
factory workers earning less than a certain amount were able to get health insurance. At the time, that was about 10% of the population; but since then more and more
people have been included, and so here we are 130 years later. There are two types of health insurance: Which type of insurance you get will depend on the type of job you have
and some other complicated factors. If you are employed by a company —
that is, you are on their payroll — you may be eligible
for statutory health insurance. How much you pay depends on how much you earn. Your employer pays a share, and the rest is automatically deducted
from your wages or salary so you don’t have to do a thing. The insurance company, known as
“Krankenkasse” in Germany, issues you with a card. When you go to the doctor or dentist or hospital,
you present this card and that’s all you need to worry about: no fuss, you get your treatment
and your medication, and the insurance company pays for it. Some other groups of people also get
statutory health insurance: those registered as unemployed, for example. Their premiums are paid by
the relevant government agencies. Private insurance is for everybody else. It’s a normal insurance policy, so how much you pay will depend
on how much of a risk you are. The younger and fitter you are when you join,
the lower your premiums will be. If you need medical treatment, you state
that you are privately insured. You later get an invoice, which you pay, and then claim back from the insurance company. If it’s very expensive you can usually
arrange to pay in installments. If you know in advance that you’re
going to need expensive treatment, then your doctor or dentist can give you
a breakdown of all the expected costs, which you can send to the insurance company and they’ll tell you
what they’re prepared to cover. This whole system — the insurance companies,
the hospitals, the doctors, the nurses, the dentists and so on, is not run by the government. This avoids the pitfall of, for example,
the British National Health Service, which is a vast bureaucracy and swallows a massive 18%
of the government’s entire budget. Instead, it’s delegated to various
non-government associations and companies, but they are very carefully
regulated by government. The German constitution puts the federal
government in charge of the broad policies, but not the day-to-day running. This, then, avoids the pitfall
of, for example, the American system, where health insurance can be very expensive and you suddenly discover you’re not covered
for something very important and very expensive, and everything is run for profit. Health insurance in Germany is
a statutory requirement; which does make it sound as if not getting
health insurance will land you in jail, but that’s not the case. What it means is that
statutory health insurance companies must accept people
who can’t get private insurance. If you have no insurance,
you’re not breaking the law; but eventually you’ll be asked to pay all the
premiums you should have paid, but didn’t. Unfortunately, I’ve never been seriously ill… …which is a very weird sentence to be saying. Unfortunately, I’ve never been seriously ill, so I can’t give you the benefit
of any first-hand experience of German hospital care. But it does have a generally good reputation. And while it’s not perfect, it does normally
give you access to good quality healthcare. And whatever your income, you should
be able to easily afford it. I think that counts as a success. Thanks for watching. If you’d like to
send me a postcard, here’s the address. And don’t forget to visit my website
and follow me on Twitter and Facebook. Also, if you’d like access
to special bonus content and help with the costs of running this channel, please consider making a small
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59 Replies to “Healthcare in Germany”

  1. Well explained. You could have added that children and even an unemployed wife are covered by the fathers insurrance. So a family father with an income of 3000 euro pays 390 Euro per month for the whole family. Cancer treatment and organ transplantation included.

  2. Hi, das Gelände von Areva hat gebrannt, das ist ja ganz in der Nähe (Karlstein)… Magst du darüber ein Video machen? Ich weiss es ist nicht was du üblicherweise machst.

  3. allmost right. for employees it also depends on the income, over a certain amount you can/must choose if you want private health insurance. At the moment (2017) you can change into it when you earn over 56700€/year (bruto)

  4. For hospitals: You have to pay 10€/day when you are in a hospital up to 28 days/year (=280€).
    Normal things are mostly covered by the insurance. Things like professional dental hygenist treatments or special fillings at the dentist must be payed privately.

    Additional you have to pay 5€ when you go to the pharmacist for your medication (prescription medication). But you can ofc buy medication without a prescription like painkiller or coughing syrup.

    But all this is fairly expensive. You have to pay quite a percentage of your income (about 15%).

  5. It should be mentioned that statutory healthcare doesn't cover everything one might need or want to be covered. If one needs to have a simple check to determine whether or not one needs glasses, it isn't covered. Neither are glasses or the frame. If one needs a hospital stay, one has to pay 10 Euro per day. And if one needs prescription medicine one has to pay 5 Euro or more per medication. Every now and then one is lucky to get a generic product which is free of charge.

  6. das gesundheitssystem ist furchterbar.. es hängt alles am geld, nicht am wohlsein..

    ich bin sehr unzufrieden mit dem gesundheitssystem.

  7. A bit as well: childless men and women (either through biological or legal means) after their 23rd birthday will have to pay 0,25% more in their healthcare insurance (Pflegeversicherung) premium. And if you move between EU member countries you should inform your previous insurer as they will not be covering your insurance in the new country of residence (due to differing laws and legalese).

  8. in sachen msra belastung der hospitale ist deutschland zumindest noch besser gestellt als england, usa und/oder frankreich. ob das was mit krankenkassen zu tun hat bezweifle ich allerdings, gibt aber zumindest aufschluß über dessen qualität.

  9. My general practitioner once had me sent to hospital because he suspected a pulmonary embolism. I got an IV, a blood test, an ultrasound from ankle to heart, a x-ray of my lungs and an ECG. All I had to pay was 20 or 40 € (I can't remember how much) for the bed I occupied for the one night and two days I stayed there.

    And when I had my wisdom teeth removed, I only had to pay the Rezeptgebühr at the pharmacy for the antibiotics and the pain killer.

    Those are my experiences.

  10. You missed out that, with the new version of the health insurance card, the "eGK" (elektronische "Gesundheits"karte), the health insurance now also gets all your most private and intimate health data to make money with, in addition to the premium you pay.

  11. Germany is the only country whose healthcare system has been invented by an herring. But seriously: The invention of the healthcare system was part of the anti-socialist laws, by which socialist parties and so on were forbidden. Bismarck on the other hand wanted to offer people with low income an alternative to socialism.

  12. It took me a while to navigate (thankfully they've now scrapped that confusing procedure which involved paying ten euros quarterly), but I can only speak positively of the German healthcare system. Okay, I have had a few bad experiences with lousy doctors and their customary German rudeness, but the good thing about Germany is that there's usually no problem seeking a second opinion and you don't have to wait forever to see a specialist. I got very ill last year. I remember going to a new Hausärztin, who arranged a blood test. She then rang me up with the results the next day before I'd even got out of bed. Apparently, I gave both the Arztpraxis and the laboratory a fright when they saw that my haemoglobin level had gone down to 6.3. But the doctor was excellent. Got straight on the phone to two haemotologists and arranged an Überweisung to the nearest clinic. Five iron transfusions later, all's good.

  13. The german healt system is very expensive and uneffective, with burocracy growing more and more.
    As a normal person you have to pay like in a socialistic system, without any choices. On the other end it is a capitalistic system with pharmaceutic companies and privatised hospitals trying to maximise their gains.
    Drugs are within the most expensive in the world, costs are the third expensive in the world, but the quality of treatment you get is just mediocre compared within europe.
    They don´t pay for glasses, they barely pay half of dentist costs, but they pay fully if you want to change your sex and have a gender-changing operation.

  14. I notice you mentioned, or at least implied, that the NHS might be something other than a shining beacon of perfection. Anyone in Britain who says that is immediately slammed as "insulting our hard-working doctors and nurses", and probably lynched. Which might go some way to explaining how it became such a massive and expensive bureaucracy…

  15. Aber es ist nur günstig, wenn man einem Arbeitgeber hat. Wenn man keinen hat, darf man im Monat bis zu 500 € für die Krankenversicherung los werden!

  16. Great video. I live in Australia and asked myself how to explain the German system to my Aussie friends. Good on 'ya Rewboss!

  17. So, how does one acquire health insurance when first coming to Germany?
    Asking for a friend
    (No really, I'm German myself, so I never really had to go trough the process)

  18. The problem is, it seems to be massively expensive. My wife is paying 250 euro a month (she has zero income) and putting me on with her would be an additional 600. I'm retired (pension from the US and its not a huge amount) and just can't afford it. What good is 'good' insurance that you can't afford. They are looking to extract a third of my income just for health insurance. Very disappointed with the situation in Germany.

  19. wait wait wait, "warmongering" ? You know how established one of the longest times of peace between the major european countries and created a system of alliances that prevented from Europe turning into a battleground. I know one might assume that he liked war based on the 3 wars he started to unite the german people but that was from his point of view just a way of means. A tool.

    Bismarck never liked war, for him it was merely a necessity to accomplish his goals. Later, he is the one responsible for an era of peace in Europe.

  20. It#s a little bit misleading to say that you can get statutory health insurrance if you're eligible and otherwise have to get the private variant. I'm NOT an expert on the matter, but it's generally seen by Germans this way:
    When you start working, you either get into the statutory system with one of the providers who still have names indicating that there was once a bit of a separation by type of work. Or you chose to go with the private inssurance companies, who offer more services and cover more things, but at a potentially higher cost, depending on your age and other factors.
    If you have a good paying job, it may be smart to go private or at least pay for additional services, becasue German statutory health care generally only covers the basics. That's medical neccessities, which is a good thing, but the reason you hear Germans bitch and moan about the system is that the companies are always trying to reduce the amount of things covered. So, what actually IS a neccessity is sometimes hotly debated.
    Mostly, you gotta pay some money from your own pocket if you want decent coverage. Dental is a prime example for that. Staturory covers ceramic inlays for the front area, but you only get the old, not so nice looking stuff for the back teeth, if you can't or won't pay extra for ceramics. Another debated topic is that prevention is often not or not fully covered.

    It's not that the system is terrible. Especially not in comparison to many other countries. But if you live long enough with it and see what's taken away from what's covered, it can get frustrating. Even for the people who are generally healthy.

  21. Das erinnert mich irgendwie an einen italienischen Film, den ich vor über 20 Jahren im TV gesehen hab' – zumindest die deutsche Übersetzung ist mir im Gedächtnis geblieben:
    Der Film spielt in einem Hotel, und es Herrscht das Chaos. In dieser einen Szene betritt der Hoteldirektor mit einem Arzt das Zimmer eines wichtigen weiblichen Gasts; diese ist bewusstlos (warum weiß ich nicht mehr). Es folgt folgender Dialog:
    Hoteldirektor: »Oh mein Gott! Herr Dr., wird sie überleben?«
    Arzt: »Privat oder Kasse?«
    Hoteldirektor: »Herr Dr.! Es geht um Leben oder Tod! [und natürlich um den Ruf des Hotels] Wird sie überleben?«
    Arzt: »Privat oder Kasse?«

  22. I went to London once and was a bit in a hurry to get to the airport. Busy enough to forget my glasses and emergency contact lenses. So all I had on me were my lenses that i wore at the moment. Of course Murphys Law struck and one of my contacts broke the next day. Being blind without them I went to the next optician in London to get some cheap daily lenses for my trip. I was much surprised when the clerk told me I had to get to an eye specialist first and get a valid recipe because otherwise she couldn't sell them to me. I told her that I am German and that I can't just walk up into the doctors office in England and get a treatment. She ask me then how we do this in Germany and I said I order my contacts online and haven't been to an eye specialist in ten years… I found that episode particulary fascinating because I always assumed that health care is much more regulated in Germany than it is in the UK… but the women in the store was adamant and I had to squint one eye for the next three days…

  23. There is a third (rare) form: "Freie Heilsfürsorge". I don't really know much about it, though.
    There are some other facts:
    – Technically you ARE breaking a law when having no insurance, but you won't be put to jail, because target of the law is to get everybody insured, not to incriminate people. If you have no insurance at all (which is difficult to achieve because you can't cancel your old insurance without having a prove that you already have contracted a new one), you'll have to pay up to 6 month's full premiums when getting a new insurance and half premiums for every further month without insurance, so you are very likely to have big debt afterwards.
    – Not being able to pay your premiums doesn't leave you without insurance. Even if you are in a private insurance, they have to give you a socalled "Notlagentarif" (emergency rate?): Your premiums will decrease to a very low level until your debts are paid, but you will still receive emergenca care.
    – There are some more differences between statutory health care and private health care worth mentoining: statutory health care will only pay for normal health care, while private health care normally pays for some extras like single bed rooms in hospital or experimental treatments. Still, for a young and healthy person, private health insurance tends to be cheaper. But this is going to change: While statutory health insurance's premiums are bound to your income and so they will decrease if you loose your job or get pension, private health insurance's premiums are only bound to the risk you are to the insurance company, so the premiums will rise the older you get.
    – It's easy to switch from statutory health insurance to private health insurance once you earn enough money. It is, on the other hand, nearly impossible to switch back from private health insurance to statutory health insurance. After you became 55, there are only very very rare cases were you are able to switch back and those are in a legal limbo.

  24. Dear rewboss,

    although the coverage in german healthcare ist very good – as you explained, there is coverage for nearly everything – the german healthcare-system lacks of beeing integrated or holistic. the term family health care ist totally unknown. The concept of community health care – same thing. Nevertheless it is diffucult if not impossible to approach the complexity of mental and physical health if the GP, the psychologist, the specialists, all see the person in a different context and have no communication at all , not to mention the lack of access to the case history (each professional has his own records).
    Currently there are health problems, mainly the increasing cardiovascular diseases, that need an integrated approach very urgent.

  25. but you didnt explain that for the statutora health insurance, there are several 'Krankenkassen' and also that based on which you are registered, the treatment is not the same on every hospital. Krankenkassen negotiate the fees with the hospitals and there are cases that you might be on a waiting list, because of the budget set between the hospital and the Krankenkassen. The same for the private practises, where you might need to pay the excess between what is covered and the price of the practise.
    The private insurance is very expensive and again it depends on your 'status'. It might go up to 450EUR per month..
    As a foreigner in Germany, I was 'discriminated' even if I had the insurance card, because I didnt have German nationality, despite being a permanent resident, because they had a risk that I wouldnt pay. So even if I was covered by the insurance, they asked me to pay the treatment BEFORE going to the doctor, to make sure they were getting paid.

  26. German health insurance system: Pretty neat but they do not pay everything. Mediction is mostly payed by yourself (standard meds) and very costly in Germany (rather take a trip to neighbouring states and get the meds there for half the price or less), or subsidized. Dental stuff is only covered in the basics, for implants or fancy materials you gotta have a private insurance or pay by yourself. About German hospitals, there are good ones and bad ones. The problem since a few years is that almost all hospitals have to generate profit now, and together with the Fallpauschalen system it creates a mess; you either get not enough treatment stationary because they cannot make anymore money with your case, or they try to tack on stuff so they can cash in on the insurances. Also, German hospital hygiene is a mess. I would rather go to the Netherlands than to a hospital here. ( Of course, compared to other standards like in East Europe or outside of Europe, it is a good standard. But hopefully you have never to experience the hospital system first hand… also never go the the hospital if you are sick. See a doctor or call an ambulance, the hospital will let you wait many hours together with coughing sick people in a room.

  27. Thankfully you've never been seriously ill. Here is my personal case of major illness as an example of how the krankenkasse works: I had a accident at a public pool causing a multiple fracture in my left elbow. I was taken to the hospital+operated on and had 2 weeks of additional service in the hospital where they took care of the wounds cleaning and binding (i had a fixateur for 6 weeks after being discharged from the hospital) this cost me the 10€/day charge for the hospital stay (10 days in my case). I had to pay some addtional charges for the pain meds. In the meantime my employer was informed this was going to be a lengthy illness (I was out from work for 6 months-.-), they received some compensation pay from the krankenkasse for keeping me employed and to basically hire a replacement for the time I was out. After 6 weeks of illness my employeer did not have to pay my wages instead I received krankengeld which amount to 80% of your actual wages. Eventually the fixateur was replaced by another contraption which steadied the elbow but could be removed at whim, for this I had another additional 20 € charge. A very intensive therapy time followed in which I had 2-3 sessions a week. This also cost me 20€ for every 6 sessions. At this time I reached the max "zuzahlung" that you had to make for my wage bracket and the rest of the therapy and meds etc was free of charge for the rest of the year…You do have to keep all your receipts and drop them by the krankenkasse (and of course the krankenkasse does not actually tell you about this you have to get yourself informed) On the whole I was rather grateful for all that was provided but keeping up with the paperwork and things can be hassle plus I am seriously sick of seeing my ortho-doc every two-three weeks since the therapy receipes can not be made out for more than 6 sessions…hope that explains a bit more about the "serious" illness-side

  28. Bismarck, the "war mongering totalitarian politician"?
    Please "lass die Kirche im Dorf"…
    He was no fan of war, each time he went into war it was because of other nations declaring it on Prussia. He played some part in provoking it because he felt those conflicts were inevitable, but still the other nations went to war because they wanted to, not because they were forced to.

  29. Ahha, that's what we need here in America!For those who think that the Scandanavian system is,"Socialism",the German system whould be perfect.

  30. You can always get statutory insurance no matter how much you earn and where you work and some poeple choose to do so, for example because more well of people choosing private insurance is bad for the statutory insurers and thus there is a danger of a two class medicine developing. Or simply because in some cases you earn enough to get private insurance but it might still be more expensive. However sometimes you might get additional services that are not mandatet by law with some private insurers.

  31. Technically you are breaking the law if you are not insured; since 2009 there is the "Versicherungspflicht" (requirement to be insured) as codified by the Sozialgesetzbuch (social laws). Every citizen has to be insured – in turn the statutory insurance companies have to accept every citizen as their clients. People can choose to be insured by a private insurance company instead of the statutory ones – the premiums for private insurance usually is (often significantly) higher, in turn private insurers often offer to cover things that statutory health insurance does not, like single-bed rooms in hospitals, or "alternative" treatments like homeopathy. There are also certain jobs that come with their own company-provided health insurance programs/providers, which essentially act like a private insurance.

    The case you mentioned where people are not insured and have to pay large sums when applying for health insurance again is something that does exists, but it's mostly an unintended side effect of the introduction of the Versicherungspflicht in 2009. If you were self-employed at the time of the switch, neither an employer nor the state job/social agency (responsible for paying health insurance cost for unemployed people) would notice if you didn't have coverage – and many self-employed people "dodged" getting the legally mandated health insurance to keep their expenses down. This however created a vicious cycle: When people apply for health insurance, and it turns out they have not been covered before that, the insurer retroactively covers those months, however they also retroactively demand the premiums for all those months (plus fees, because technically the people are "overdue" paying). This means that many people who fell out of the system because they needed to save money during hard times couldn't afford to get insured when business was better because of the piling up back-fees they would have to pay – so some people stayed in this health care limbo for years and years, not going to the doctors, etc. That problem was acknowledged by the state as a problem in 2012 (or 2013, don't exactly remember), where statutory ensurers offered – for a limited time – an "amnesty" (waiving the premiums for the month people were not insured) for uninsured people who applied for health insurance, in an attempt to bring these people back into the system. Sadly this initiative received relatively little public attention, and today there are still people stuck in the no-health-insurance limbo, technically breaking the law.

  32. Ich finde, dass es hier so dargestellt wird, als ob die private Krankenkasse das normale darstellt, dabei ist die GKV der Normalfall! In die Private kann man reingehen, wenn man ein gewisses Bruttojahreseinkommen überschreitet oder Beamter ist. Ansonsten landet man automatisch in der GKV. Selbstständige können sich zwischen beiden Systemen entscheiden. Die GKV ist meiner Meinung nach der absolute Normalfall für den Großteil der Bevölkerung in Deutschland.

  33. well, it's nice and all, except for when you don't have a job and don't get money from the state, because then you have to pay double the normal price (or even more) and are basically in dept for the rest of your life. Same thing for when you only have a "Mini-job", because then your employer dosn't have to pay a thing and you are stuck with the full price, so in the end you either starve, can't pay the rent or are in dept.
    I heard that there is quite a number of people in dept because of this system.

  34. Great topic thanks! It is covering several points. Videos are always more easy to follow. I found lot's of valuable info about this topic also here:

  35. Many things are not good in the german system, especially if you suffer of severe illness like cancer… or if you have heart problems… and there is extremly lot corruption

  36. It does sound like a good system, but all that invoicing and billing must me an absolute nightmare. NHS England avoids this. However it is used as a political football. Remember Boris' big bus of lies!

  37. As an American, I have never ever seen an insurance company NOT cover something. Why that is an assumption is beyond me, but its NOT true. In 07, I paid almost nothing out of my paycheck and got full coverage. Fast forward to today and a pay 300 per month and have a 2500 deductible thanks to Obamacare. Government destroys it does not improve.

  38. It seems to me that 18% of the budget of a government going towards keeping its population healthy and well shouldn't, on its face, be considered 'massive'.

  39. Got a shoulder injury when I lived in Germany. Didn't have to go to the hospital, but the service at the doctor's office was exemplary. The visit was quick (but didn't seem rushed), and got a note (for work) as well as a medicine slip even without asking.
    Medicine was about 5€ for two packs of strong ibuprofen, some pills to protect my stomach fron the high dose of ibu and a dripper bottle of muscle relaxant…. something that would easily have cost ten times as much in Denmark.
    Even though I was out of commission for two weeks at the time, it was mostly bearable.
    Some other procedures, like getting blood tests, can be completed on the spot or takes a day or two at most…

    …. just don't get into the wrong insurance company, or you will regret it when you're out of employment….

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