The German health care system

[Steffi]

My English might be not good enough for that kind of discussion but anyway.... Here's our system: ;)


The Federal Republic of Germany is composed of sixteen states, the so-called „Bundesländer“ or “Länder”. Germany has one of the highest population density within the European Union. In December 2005 the number of doctors was 373 per 100,000 inhabitants. Healthcare is funded by a statutory contribution system that ensures free healthcare for all via sickness funds. Insurance payments are based on a percentage of income, divided between employee and employer. Healthcare insurance in Germany is divided between statutory and private schemes. The statutory health insurance, the so-called “Gesetzliche Krankenversicherung” (GKV), occupies a central position in the Healthcare system in the Federal Republic of Germany. About 90 % of the population are covered by the statutory health insurance which is compulsory for all who earn less than 3862,50 € (in 2004) before tax. Private healthcare schemes can either provide to complete health service for those who opt out for the GKV or top-up cover for those who remain within it.

In Germany, the provision of healthcare can be broadly separated into ambulatory and in patient sectors. Outpatient services supplied to the public are largely the responsibility of independent doctors practising on a freelance basis under contract to the statutory health insurance. Doctors caring for patients who have sickfunds must be registered by law by the regional association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung).

Hospitals in Germany are grouped into three main types:

Public hospitals (Öffentliche Krankenhäuser) run by the local authorities, the towns and the “Länder”
Voluntary non-profit making hospitals (Frei gemeinnützige Krankenhäuser) run by the churches or non-profit making organisations such as the German Red Cross
Private Hospitals (Privatkrankenhäuser) run as free commercial enterprises

http://www.bundesaerztekammer.de/page.asp?his=1.109.112.3313


The German health care system has the reputation of being one of the best in the world. There is an extensive network of hospitals and doctors covering even the remotest areas of Germany.
Waiting lists for treatments are rare. Medical facilities are equipped with the latest technology and the statutory health insurance scheme provides nearly full cover for most medical treatments and medicines. Almost everybody in Germany has access to this system, irrespective of income or social status.

http://www.justlanded.com/english/Germany/Germany-Guide/Health/Introduction

[JLB123]

Your English is good except that over here Obamacare is the "scheme".

[Tybee]

http://i457.photobucket.com/albums/qq294/hali436/800px-Income_Taxes_By_Country_svg.png

[Steffi]

I know that but I thought if you talk about universal health care over there you might also want to compare the systems from other countries and how it already works there....

[JLB123]

http://i457.photobucket.com/albums/qq294/hali436/800px-Income_Taxes_By_Country_svg.png



Wow!

That free health care sure is expensive.....

[Steffi]

I pay 7,9 % from my pre-tax and my employer pays 7 % for me. With that I get full coverage and don't need to think whether a doctor medicates me. The system has it's problems but we are still complain on a high level.

[JLB123]

I pay 7,9 % from my pre-tax and my employer pays 7 % for me. With that I get full coverage and don't need to think whether a doctor medicates me. The system has it's problems but we are still complain on a high level.

That is outrageously high for free healthcare. 15% of what you and your employer make go out the window. In America we don't have to pay nearly that much.

Over here we have the Congressional Budget Office, which keeps track of what things will cost.

Obama wants to cover 49 million so-called "un-insured", many of whom are illegal aliens.

The CBO calcutaed that covering just 10 million would cost $1 trillion dollars.

I wonder where Obama will get the extra $4.9 Trillion Dollars from, in a recession?

[Steffi]

Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care.

It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies.

German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted.

Checking In With An Old Friend

Juergen in der Schmitten was a medical student when I first met him 17 years ago. Now, he's a 42-year-old general practitioner in a suburb of Dusseldorf.

On one particular night, Juergen was the doctor on call for the region. Any German who needs after-hours care can call a central number and get connected to a doctor.

Around 11 p.m., a woman with a fever called Juergen. She wanted him to make a house call. They talked for maybe five minutes, in the end agreeing that she would come into his office in the morning.

A situation like this would be unlikely in the United States. Americans might not get through to a doctor at all, let alone have a discussion about whether the physician should make a house call in the middle of the night to treat a case of flu.

The Patients' Perspective

Sabina and Jan Casagrandes say they've had really good care from the German health system. And they've used it a lot.

Sabina is American, Jan is German. They live in a fourth-floor walkup with their two little girls in Cologne, an ancient city on the Rhine in western Germany.

"I've probably been very expensive for the health insurance system here," Sabina says. "When I was 33 years old, I had a giant lump on my neck all of a sudden, where your thyroid is. And it was a big tumor."

It took two operations to remove her cancer. Luckily it was curable with surgery and radiation. Sabina says she had the best care she could imagine.

"Then I came home to my little daughter, who I couldn't really lift up because of my neck having been cut open," Sabina says. "So I asked my doctor, 'What can I do?' And she said, 'Well, your health insurance will pay for someone to come help you in the house.'"

Sabina's health insurer paid a friend to shop, cook and even help care for the baby until Sabina was back on her feet. That's not unusual in Germany. In fact, under the country's system for long-term care, family members can choose to be paid for taking care of a frail elder at home if they want to avoid nursing home care.

Coverage For All

The health care system that took such good care of Sabina is not funded by government taxes. But it is compulsory. All German workers pay about 8 percent of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.

Basing premiums on a percentage-of-salary means that the less people make, the less they have to pay. The more money they make, the more they pay. This principle is at the heart of the system. Germans call it "solidarity." The idea is that everybody's in it together, and nobody should be without health insurance.

"If I don't make a lot of money, I don't have to pay a lot of money for health insurance," Sabina says. "But I have the same access to health care that someone who makes more money has."

But she acknowledges that nearly 8 percent of her salary is a sizable bite.

"Yes, it's expensive. You know, it's a big chunk of your monthly income," Sabina says. "But considering what you can get for it, it's worth it."

Actually, it's about the same proportion of income that American workers pay, on average, if they get their health insurance through their job. The big difference is that U.S. employers pay far more, on average, than German employers do — 18 percent of each employee's gross income versus around 8 percent in Germany.

More Added Benefits In Germany

Moreover, German health insurance has more generous benefits than U.S. policies cover. There are never any deductibles, for instance, before coverage kicks in. And all Germans get the same coverage.

For instance, the Casagrandes' insurance covers an expensive medicine Jan needs for a chronic intestinal problem. He says if they moved to America, they might not be able to buy insurance at all because of their pre-existing conditions — a nonproblem in Germany.

"He says for himself — or for us — the health care system in the United States is the major reason why we have never moved there, and never will move there. Because both of us have chronic illnesses that have to have a lot of medical attention, and we would go broke," Sabina says, translating for Jan.

Jan adds something else. "It's also the No. 1 reason in the United States that people personally go bankrupt," Sabina translates, "which would never happen here ... never!"

Coverage For The Family

On the other side of Germany, in Berlin, we meet another couple who know both the American and German health systems.

Nicole and Chris Ertl own Tip Toe Shoes, a children's shoe shop in a well-off area of the German capital. The Ertls sell high-quality European shoes — tiny Italian sandals, French and Danish boots and clogs in wonderful colors.

Chris is from San Diego, Nicole is German. She also works part time as a physician therapist and gets her health care through her job like the great majority of Germans. Like the Casagrandes, she's happy with her coverage.

"It's a good deal!" she says. "It's really good because it's a package."

It's a package many Americans might envy. Nicole pays a premium of $270 a month for insurance that covers her children, too. Nicole pays a single $15 copayment once every three months to see her primary-care doctor — and another $15 a quarter to see each specialist, as often as she wants. She pays no copayments for her children's care —-and her insurance even covers her daughter's orthodontia bill.

"They always have good care," Nicole says, "because for kids, everything is free. The drugs, it's always free" until they turn 18.

Different Rules For The Self-Employed

But even though her insurance covers the kids, it doesn't cover her husband. Because Chris Ertl is self-employed, he has to buy insurance on his own, from a for-profit insurance company.

About one in 10 Germans buy this so-called "private" coverage. It's not just for people who are self-employed. Civil servants and anyone who makes more than $72,000 a year can opt out of the main system. It's a kind of safety valve for people who want more and can pay for it.

But most people don't opt out. Chris says that's because there's a fundamental difference in the way Germans view health care and the government's role — which, in Germany, means refereeing the system and making sure it's fair and affordable.

"The general opinion in Germany is always that the government will do it for us, everything will be OK," Chris says. "In the States, I think you grow up knowing that no one's going to help you do anything. If you want health care, go get it."

It's important to remember that the German government doesn't provide health care or finance it directly. It does regulate insurance companies closely — the nonprofits in the main system and the for-profits where Chris gets his coverage. So Chris' insurer can't raise his rates if he gets sick or jack up his premiums too much as he gets older. The government also requires insurers to keep costs down so things don't get too expensive.

"Where am I better off medically?" Chris says. "I would probably say Germany."

In some ways, Chis Ertl's coverage is better than his wife's. He gets his choice of top doctors — the chief of medicine, if he wants. If he goes into the hospital, he gets a private room. When he goes to the doctor, he gets a free cup of coffee and goes to the head of the line. All this embarrasses him — and annoys Nicole.

"When he goes to the doctor, he has a lot more service," she complains.

Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.

But it's unthinkable that 48 million people wouldn't have health insurance at all — the situation in America. As an American, Chris thinks that's shameful. "It's terrible," he says. "It's unbelievable. It shouldn't happen."

Germans, he says, would never tolerate that. And their system has been working pretty well for 125 years.

Radio piece produced by Jane Greenhalgh.


http://www.npr.org/templates/story/story.php?storyId=91971406

[JLB123]

Steffi, NPR is a leftist site. What would you expect them to say?

[NoFear]

Steffi, NPR is a leftist site. What would you expect them to say?

Right..because anything that isn't Fox is left leaning...Reality has a well-known liberal bias

[Steffi]

Steffi, NPR is a leftist site. What would you expect them to say?

That article describe our system very well so I didn't care about to where that site is leaning.

[JLB123]

Right..because anything that isn't Fox is left leaning...Reality has a well-known liberal bias

Reality is to a liberal like a cross is to a vampire.

[Spang]

Reality has a well-known liberal bias.

[foxyladi]

thanks Steffi for this great article.i learned a lot from it.

[sadie]

thanks Steffi for this great article.i learned a lot from it.

I did too, thanks for posting. I've always heard good things about the German system. Didn't Farrah Fawcett go to Germany for treatments not available here in the U.S.? I think it's interesting that Germany has remained medically innovative with such a system...and if I understand correctly, everyone gets access but those with private plans get other perks and quicker service, correct?

I'm all for affordable healthcare, contrary to what some on here believe about my views...I just don't want the government involved. I will never simply resign myself to the fact that I have NO say in how my tax dollars are spent. Therefore, I will always seek to pay as little as possible, because I do not trust those who lead this country. It's no longer about the well-being of Americans...but about the well-being of those who allegedly represent Americans. It's a constant bid for re-election and power, and I'm sick to death of it.

[CGP]

Steffi, NPR is a leftist site. What would you expect them to say?

Rather than dismiss the source, it might be more constructive to respond to the contents of the article.

Fox News is right-leaning but I find useful articles on there. I have also found interesting articles on conservative websites and haven't canned them outright simply because of where they originated from.

[CGP]

That article describe our system very well so I didn't care about to where that site is leaning.

:thumbsup:

[Ikasu]

Germany is a top country for engineering, along with the US and Japan. That's why they are able to maintain a high quality medical system. And it's why the US can too.

[Aria]

Steffi - I appreciate the information you've given us about health care in Germany. Coincidentally, I heard on the news tonight that 55% of Germans are dissatisfied with their health care. Do you think that agrees with what you know of the feelings in the country as a whole? (Sorry, I didn't catch where the info or poll came from, but it was on CNN). Is there anything that you consider unsatisfactory about it?

[PA_Voter]

I'm all for affordable healthcare, contrary to what some on here believe about my views...I just don't want the government involved.

I'll assume that 14.9% is for access to the Public Hospitals and you noticed they are run by the "local authorities".... Sounds like government-run hospitals.

My friends in Germany said they wouldn't be without their Private Insurance, but I guess it's like choosing to send your child to a Catholic School here, you can pay for their education and pay for it again by paying the Public School taxes.....

[hillary4change]

That article describe our system very well so I didn't care about to where that site is leaning.
Thank you Steffi, great article. I am glad that you have a system that works so well for your country.

[hillary4change]

It's a constant bid for re-election and power, and I'm sick to death of it.
This is how I feel as well. Politicians are all about there cushy jobs, great benefits and short work days!! (and weeks of course)

I no longer believe that we are their number one priority. :(:(

[RE:]

Great article Steffi...Thank you.

What is the percentage that comes out of your paychecks for all deductions, if I may ask? For example do Germans pay some sort of social security, Medicare, FICA, etc.? I'm just trying to figure out if your healthcare is really that expensive.:thinking:

Also, what happens when a person retires? Are they still covered or do they have to purchase private insurance? Do people that make alot of money, that choose to opt out still have to pay a percentage for healthcare on top of their private premiums and does their employer, as well?

Sorry for all the questions...:atwitsend:

[Steffi]

Great article Steffi...Thank you.

What is the percentage that comes out of your paychecks for all deductions, if I may ask? For example do Germans pay some sort of social security, Medicare, FICA, etc.? I'm just trying to figure out if your healthcare is really that expensive.:thinking:

Also, what happens when a person retires? Are they still covered or do they have to purchase private insurance? Do people that make alot of money, that choose to opt out still have to pay a percentage for healthcare on top of their private premiums and does their employer, as well?

Sorry for all the questions...:atwitsend:

LOL, don't worry. :) It's very early here and I cannot really think in English but I'll answer all the questions after work this evening. ;)

[RE:]

LOL, don't worry. :) It's very early here and I cannot really think in English but I'll answer all the questions after work this evening. ;)HA! And this 'night owl' will probably still be up when you get home...:eek:

[CGP]

HA! And this 'night owl' will probably still be up when you get home...:eek:

Hopefully this one (moi) won't!

[foxyladi]

HA! And this 'night owl' will probably still be up when you get home...:eek:

i.ll pick it up bright and early tomorrow:thumbsup:

[Steffi]

Great article Steffi...Thank you.

What is the percentage that comes out of your paychecks for all deductions, if I may ask? For example do Germans pay some sort of social security, Medicare, FICA, etc.? I'm just trying to figure out if your healthcare is really that expensive.:thinking:

Also, what happens when a person retires? Are they still covered or do they have to purchase private insurance? Do people that make alot of money, that choose to opt out still have to pay a percentage for healthcare on top of their private premiums and does their employer, as well?

Sorry for all the questions...:atwitsend:

I hope if you are up you are up AGAIN. :D Sorry, couldn't make it yesterday...

Our income tax depends on whether you live alone, have kids, are married... I am single and live alone so I have to pay one of the highest taxes. The other things you pay with your paycheck are the pension scheme (you are paying for the people who are old today and hope someone will pay it for you later on. That doesn't really work anymore so you have to insure yourself private too), unemployment insurance, church rate, long term care insurance and a tax for Eastern Germany (what annoys me the most because their streets are better than ours now. *rolleyes* All that together with the health insurance means about 800 € taxes every month from my wage.

If you retire you are still covered.
I hope you can understand what I try to say here. It's a little bit difficult. ;)

[TheTaoOfBill]

I hope if you are up you are up AGAIN. :D Sorry, couldn't make it yesterday...

Our income tax depends on whether you live alone, have kids, are married... I am single and live alone so I have to pay one of the highest taxes. The other things you pay with your paycheck are the pension scheme (you are paying for the people who are old today and hope someone will pay it for you later on. That doesn't really work anymore so you have to insure yourself private too), unemployment insurance, church rate, long term care insurance and a tax for Eastern Germany (what annoys me the most because their streets are better than ours now. *rolleyes* All that together with the health insurance means about 800 € taxes every month from my wage.

If you retire you are still covered.
I hope you can understand what I try to say here. It's a little bit difficult. ;)

And what percentage of your paycheck is 800€

Your English is fantastic by the way!

[RE:]

And what percentage of your paycheck is 800€

Your English is fantastic by the way!Tao, I tell Steffi all the time that her English is better than mine, alot of the time.:D:o

I actually wanted to know this too, Steffi. If you don't want to say, I would understand. I think how much a person makes should be a private matter and if you tell us the percentage, we will be able to figure out your wage.

I understood everything perfectly. The pension scheme sounds like our social security, which is broke just like our medicare/medicaid. What's the 'church rate' all about?

And if you noticed the time...I'm up late AGAIN!:laughing:

[Steffi]

Steffi - I appreciate the information you've given us about health care in Germany. Coincidentally, I heard on the news tonight that 55% of Germans are dissatisfied with their health care. Do you think that agrees with what you know of the feelings in the country as a whole? (Sorry, I didn't catch where the info or poll came from, but it was on CNN). Is there anything that you consider unsatisfactory about it?

Yes, I think 55 % sounds plausible. I'm totally fine with our system as a whole and I think we still complain on a very very high level (I still can go to a doctor and I don't have to be afraid of high bills afterwards) but there are a lot of things that went worse: Our government (and that's another reason for me to never vote for the CDU and Mrs Merkel) decided that there is a consistent premium rate for everyone (14,9 %) whatever insurance you choose. Before that you could look what insurance company had the lowest premium and than decide (mine for example had 13,something percent). AND now you have to pay 10 € every quarter if you want to go to a doctor. Moreover you have to pay nearly everything alone if you need new teeth. You better take care for them. ;) That are all things that causes discontent but I STILL don't have to be afraid of debts or that my insurance company don't cover something I really need after a bad accident (A friend of mine died after three weeks in coma and they did everything they coud and nobody has debts now) and I still get fast and competent help.

[Steffi]

Tao, I tell Steffi all the time that her English is better than mine, alot of the time.:D:o

I actually wanted to know this too, Steffi. If you don't want to say, I would understand. I think how much a person makes should be a private matter and if you tell us the percentage, we will be able to figure out your wage.

I understood everything perfectly. The pension scheme sounds like our social security, which is broke just like our medicare/medicaid. What's the 'church rate' all about?

And if you noticed the time...I'm up late AGAIN!:laughing:

You night owl answered me at 12:04 pm German time. I noticed that. :laughing: At that time I already worked 4 hours. :p

That damned church rate means if you are a member of one of the two big churches (catholic or evangelic) you have to pay that tax. :rolleyes:

[Aria]

Yes, I think 55 % sounds plausible. I'm totally fine with our system as a whole and I think we still complain on a very very high level (I still can go to a doctor and I don't have to be afraid of high bills afterwards) but there are a lot of things that went worse: Our government (and that's another reason for me to never vote for the CDU and Mrs Merkel) decided that there is a consistent premium rate for everyone (14,9 %) whatever insurance you choose. Before that you could look what insurance company had the lowest premium and than decide (mine for example had 13,something percent). AND now you have to pay 10 € every quarter if you want to go to a doctor. Moreover you have to pay nearly everything alone if you need new teeth. You better take care for them. ;) That are all things that causes discontent but I STILL don't have to be afraid of debts or that my insurance company don't cover something I really need after a bad accident (A friend of mine died after three weeks in coma and they did everything they coud and nobody has debts now) and I still get fast and competent help.

Thanks for your answer, Steffi. It's good to know that you are mostly satisfied with your health care system. I can see how you wouldn't like the higher rate being imposed upon everyone no matter which insurance you choose. I don't know what you would base your choice of insurance company on then - are there differences in what they offer? It sounds as though they are government run and would have the same offerings and restrictions.

I'm sorry to hear about your friend's death, but good to know that all means were taken to help her, and I certainly understand the benefit of leaving no debts behind. Also good to know that you can count on fast and competent help if you need to go to the doctor. Thanks for sharing with us!@};-

[Steffi]

Thanks for your answer, Steffi. It's good to know that you are mostly satisfied with your health care system. I can see how you wouldn't like the higher rate being imposed upon everyone no matter which insurance you choose. I don't know what you would base your choice of insurance company on then - are there differences in what they offer? It sounds as though they are government run and would have the same offerings and restrictions.

I'm sorry to hear about your friend's death, but good to know that all means were taken to help her, and I certainly understand the benefit of leaving no debts behind. Also good to know that you can count on fast and competent help if you need to go to the doctor. Thanks for sharing with us!@};-

Their basic offers are the same the rest differs a bit but not that much. A friend of mine changes her insurance into a private one because she's earns more money now and that's a little bit difficult: Her old insurance company wants her wheelchair back and the new one isn't ready to give her one. And here we come to the typical German phenomenon: bureaucracy. :rolleyes: But that's not only a health care problem. ;)

[Aria]

Their basic offers are the same the rest differs a bit but not that much. A friend of mine changes her insurance into a private one because she's earns more money now and that's a little bit difficult: Her old insurance company wants her wheelchair back and the new one isn't ready to give her one. And here we come to the typical German phenomenon: bureaucracy. :rolleyes: But that's not only a health care problem. ;)

BUREAUCRACY! We are very familiar with that, too - and it's one very big reason for Americans' fear and skepticism of government run health-care. Our Medicare program for the elderly, for example, has been successful on the one hand (for the patient) BUT it's running out of money. Many people feel that if the government can't handle it on a smaller scale - they could not possibly handle it for the whole nation. Government doesn't seem able to project costs into the future with any accuracy, so people fear rising taxes and/or lower quality and less care. Besides, it flies in the face of the freedom that Americans feel we have, or should have. So, we have a lot of problems here to figure out how best to handle health care costs for everyone!

[Steffi]

BUREAUCRACY! We are very familiar with that, too - and it's one very big reason for Americans' fear and skepticism of government run health-care. Our Medicare program for the elderly, for example, has been successful on the one hand (for the patient) BUT it's running out of money. Many people feel that if the government can't handle it on a smaller scale - they could not possibly handle it for the whole nation. Government doesn't seem able to project costs into the future with any accuracy, so people fear rising taxes and/or lower quality and less care. Besides, it flies in the face of the freedom that Americans feel we have, or should have. So, we have a lot of problems here to figure out how best to handle health care costs for everyone!

I think you won't find another country with more bureaucracy than Germany and we also made it. ;) You need a form for every pencil here. :rolleyes: But or government doesn't even run health care. The only thing they regulate is the compulsory coverage. And that's the biggest difference between both our countries, I guess. I also live in a free and most of the time progressive country in which I can do what I want and live how I want. But the health care thing is absolutely seen as safety. Yes, I don't have a choice if I want a insurance or not but I would never for one second think about NOT having it. I feel safe because of our social system.

[Suzan]

Great thread, Steffi! Very informative and thank you for starting it. I wish we had members from other countries who could post about their health care systems, pro and con. That would be fascinating.

[foxyladi]

this is a great learning experience,sounds like something our country might try.

[Steffi]

Right now our media discusses a typical silly season topic:

Who Should Bear the Costs of Swine Flu Vaccinations?

German health insurance companies have hashed out a compromise with the federal government over who should pay for swine flu vaccinations. German commentators say the debate should never have happened in the first place.

http://www.spiegel.de/international/germany/0,1518,642468,00.html

I cannot take something like that serious so I didn't really follow it over the last week.

[Aria]

I think you won't find another country with more bureaucracy than Germany and we also made it. ;) You need a form for every pencil here. :rolleyes:

:laughing: But you keep your sense of humor!

But our government doesn't even run health care. The only thing they regulate is the compulsory coverage....But the health care thing is absolutely seen as safety. Yes, I don't have a choice if I want a insurance or not but I would never for one second think about NOT having it. I feel safe because of our social system.

I'm wondering how your doctors are paid, Steffi. Are they salaried by the clinic or hospital where they work - at set salaries according to their level or specialty, for example? And do they work with no stipulations from the government? (It sounds so, from what you have said previously). Are there guidelines for the case of terminal illness, or the elderly?

Thanks again for sharing so much with us.:) It's good to be enlightened about how these things work in other countries!

[Steffi]

:laughing: But you keep your sense of humor!

Yes, because you need it if you for example fill in a form for your broadcasting dues. :laughing: - The most annoying contribution in Germany EVER to me. I pay me health care insurace without ever complaining but THAT tax I hate every quarter. ;)
The other big thing in Germany where you need a lot of humor is during a train ride here. :laughing:


I'm wondering how your doctors are paid, Steffi. Are they salaried by the clinic or hospital where they work - at set salaries according to their level or specialty, for example? And do they work with no stipulations from the government? (It sounds so, from what you have said previously). Are there guidelines for the case of terminal illness, or the elderly?

Thanks again for sharing so much with us.:) It's good to be enlightened about how these things work in other countries!

Ok, now that becomes really difficult for me but I'll try it. ;)

The doctors at the hospitals are salaried by the clinic. - if it's a civic one it's the city of Hannover for example. There are guidelines and wage agreements. For the doctors with their own practice it's a little bit different. They all have to be a member at the "Kassenärztliche Vereinigung" (KV). Everything works with a pointsystem which means the doctors are getting a bonus for every sick person according to their illness. How high it is is regularized by a point system. I hope that makes somehow sense... :o The doctors are not getting their bonuses directly. They are accumulated at the KV and they make sure that every doctor gets the same bonus for every patient although the insurance companies are paying after different point systems.

I work in an old people's home so I can answer the question about the elderly's. ;) We also pay a premium for a long term care insurance every month with our paycheck. Elderly's who have to live in an old people's home are classified into three "Pflegestufen". Pflegestufe 1, 2 and 3. It depends how much help you need. The insurance company pays for people in the "1" 1023,00 € a month, for the "2" 1279,00 € and the "3" 1470,00 €. The rest has to be payed by the inhabitant or at least by social welfare. You are totally free in choosing the old people's home you want. No matter if it's a civic one or a private one (I work in a private one for example).

Ok, now I'm sweating, lol.

[NativeSun]

I hope you can understand what I try to say here. It's a little bit difficult. ;)

Isch versteh' disch nischt! :p

I used to date a doctor from NRW a few years back, and we used to discuss the health care systems of Germany and The U.S. every now and then. It was through our discussions that I realized how bad our preventive medicine is here in the States. And I'm not just talking about specialty exams and check-ups. I'm talking about getting the good health message to kids at an early age in school. Do they even teach personal hygiene in school anymore here? How one trains oneself in childhood has a big effect on how they will be as adults. Just ask a dentist what problems bad dental hygiene can have on the rest of your system, particularly the heart.

Now the flipside of the equation was the difference in treatment when you are very old and sick. That seems to favor the elderly here in the U.S. better than it does in Germany. And taking 7.5% of my paycheck to pay for my insurance premium would be an increase. I probably pay about 4% right now. And what is also very important to note: Germany is about the size of the lower half (the better half) of California with about 4 times the population. So getting health care to the masses is a lot easier in Germany. Maybe we should be comparing the health care systems of Russia and China against the U.S. since they are closer in size and those other two nations have had universal health care for quite some time.

[Aria]

...Ok, now I'm sweating, lol.

Here's a towel! :D You did great - you are very knowledgeable about your system and it's very interesting to hear. Thank loads, Steffi (until I think of another question ;))!

[Steffi]

Isch versteh' disch nischt! :p

Du verstehst mich ziemlich gut, würde ich sagen. ;)



I used to date a doctor from NRW a few years back, and we used to discuss the health care systems of Germany and The U.S. every now and then. It was through our discussions that I realized how bad our preventive medicine is here in the States. And I'm not just talking about specialty exams and check-ups. I'm talking about getting the good health message to kids at an early age in school. Do they even teach personal hygiene in school anymore here? How one trains oneself in childhood has a big effect on how they will be as adults. Just ask a dentist what problems bad dental hygiene can have on the rest of your system, particularly the heart.

Now the flipside of the equation was the difference in treatment when you are very old and sick. That seems to favor the elderly here in the U.S. better than it does in Germany. And taking 7.5% of my paycheck to pay for my insurance premium would be an increase. I probably pay about 4% right now. And what is also very important to note: Germany is about the size of the lower half (the better half) of California with about 4 times the population. So getting health care to the masses is a lot easier in Germany. Maybe we should be comparing the health care systems of Russia and China against the U.S. since they are closer in size and those other two nations have had universal health care for quite some time.

I'm also a member of our works committee and we discuss the problems nearly every week when we having a meeting. Problems are big and I really don't think who to start: With Frau von der Leyen's (CDU) decisions or with Frau Schmidts (SPD) decisions. Both are having impact on my job.

[Steffi]

Here's a towel! :D You did great - you are very knowledgeable about your system and it's very interesting to hear. Thank loads, Steffi (until I think of another question ;))!

Thanks. ;) I really didn't have a grammar lesson for 15 years now. :o

LOL, just ask. - I thank God and the US for Wikipedia and Google and Germany for the translator I use here all the time. :laughing: