The German healthcare system is one of the oldest ones in Europe, dating back to the 1880s and certainly considered by many people as one of the best of its kind in the world. This can be proven with the 12th position in the 2018 Euro Health Consumer Index ranking. However, this position has been changed since 2015 and 2016, when the country occupied the 7th place, staying behind such countries as Switzerland, the Netherlands, Norway, Denmark. On the whole, Germany has been praised for the level of choice given to customers in terms of treatment with the same time critics for the low number of specialist hospitals, therefore this affected its score on quality.
Since 2009, every person with a permanent place of residence in Germany is obliged to take out health insurance, even for short-term stays, otherwise, a visa will not be issued. Most of the country residents, including foreign students, employees, volunteers, etc., receiving public healthcare, and only around 10% are insured by private organizations.
Public health insurance
There are different groups of people who must have this type of insurance, in particular:
- Employees (gross income below the income threshold for compulsory insurance). In 2020 if this number is less than 62,550 Euros per year or 5,213 Euros per month. If the gross salary exceeds that amount, to have private health insurance instead is possible. Additionally, freelancers can have public or private insurance, regardless of their income. Thus, if you are employed in Germany your employer pays half (7.3%) of the total public health insurance fee. At the same time, every insurance company is also allowed to demand additional payment from their members in order to cover their costs and the average declared percentage amount is approximately 1.1 %, in 2020 this means that the total is 15.7% of gross salary with the majority of insurance companies. Overall, the amount of money you pay is not dependent on your health conditions.
- Pensioner (if the pre-insurance period is fulfilled).
- Recipient of unemployment benefit.
- students, self-employed and insured persons without income should pay the full additional contribution by themselves;
- public health insurance allows to include family members (husband/wife and children) for free;
- it is a "pay as you go" system – there is no saving for an individual's higher health costs with rising age or existing conditions.
Taking into account mentioned above, it is needed to point that most German residents (approx. 73 million people) are members of the government (public) health system. To cover the demand this type of insurance is administered by 108 public health insurance companies (Krankenkassen). Some examples of them:
- Ersatzkassen (EK), Allgemeine Ortskrankenkassen (AOK),
- Betriebskrankenkassen (BKK),
- Innungskrankenkassen (IKK),
- Knappschaft (KBS),
- Landwirtschaftliche Krankenkasse (LKK)
On the contrary to the previous one, in the private system the premium to insurance company:
- is based on an individual agreement between the insurance company and the insured person defining the set of covered services and the percentage of coverage;
- depends on the scope of benefits chosen and the person's risk and age of entry into the private system;
- is used to build up savings for the rising health costs at higher age (which is required by law).
Since private health insurance is usually more expensive than public health insurance, the higher premiums must then be paid out of a lower income. Additionally, not everyone can be part of private health insurance. The following groups of people are often insured with this scheme:
- Employees (only if their gross income is above the income mentioned above 5,213 Euros per month).
- Self-employed persons and freelancers.
- German civil servants.
- Persons working part-time and earning less than 450 Euros per month (mini-job, volunteers).
The insured person initially pays any treatment costs in advance and then, the insurance company reimburses these costs upon submission of an invoice, so-called cost reimbursement principle. In my opinion, it is pretty transparent and a person can see all the services/procedures that were given (sometimes doctors even charge you for speaking in English!).
If you are foreigner
As a volunteer, I have private insurance from Cigna. In general, I am relatively satisfied with the service, since being privately insured sometimes means that you get appointments earlier than the other people with public insurance. Honestly, this is a strange feeling to be privileged in the country, where normally I don’t feel like that. Unfortunately, I needed to attend doctors many times during my voluntary service and received invoices with a large amount of money to pay (some of them were even exceeding my monthly income!). Nevertheless, on those occasions, my hosting organization, who paid to the doctors in advance, helped greatly. Otherwise, I would need to wait for 4-6 weeks before getting the reimbursement back. So this is one of the disadvantages of being privately insured.
Normally, for international people insurance companies are having special policies and rates that are adapted to the needs and length of stay, which must be proved as well. Moreover, the insurance expiries once the person returns back home or the coverage can be extended for 1-2 months, but only in the home country.
Students from non-EU countries take out either public or private health insurance in Germany during their stay. From the age of 30 or after the 14th semester, students in Germany no longer have government coverage; they must take out private insurance. And respectively should pay more, so it is another advantage of being young and pay less fee.
It is also needed to say that in some cases not everything is covered by the insurance and before making any serious procedure or operation the person should check it with the insurance! Then, supplementary insurance can be used to fill care gaps in health insurance. It is concluded with a private insurance company, regardless of income, and regularly includes such types of supplementary insurance: nursing, dental or hospital care.
Even though, Germany is having a high level of customer satisfaction in the healthcare sphere and one of the biggest spenders on healthcare in Europe with the multi-payer model for medical insurance funded by the government, employers, and private individuals. The public healthcare system is heavily subsidized by the government and is covering the majority of the population with a lot of advantages. Although in Germany it is reported some of the lowest waiting times, in some cases for specific procedure or examination you can wait for an appointment even 5-6 months! The other things apply to the holders of private insurance, including foreigners and people with a higher income, who can get a visit even in the same week. As for me, of course, such a system may be stable and works well, but simultaneously somehow divides society.