As a welfare state, a fundamental principle in Germany is that everyone is entitled to medical services, regardless of their income. The Karlsruhe TechnologyRegion has a dense network of hospitals, medical practices and pharmacies. Many physicians, in particular in cities, also speak foreign languages, especially English.
The German healthcare system distinguishes two forms of treatment:
- Out-patient treatment refers to all healthcare services provided by facilities other than clinics (emergency hospitals, specialist hospitals, rehabilitation clinics).
- In-patient treatment covers healthcare services provided in hospitals and in-patient medical rehabilitation as part of statutory health insurance.
This section will provide you with a basic overview of the structures of the German healthcare system, including health insurance, the healthcare card, consulting physicians, hospitalization, emergencies and preventive measures.
If you become ill, the costs of consulting physicians, staying in hospital, therapies, medication and other services can be very high. The health insurance system exists to ensure that everyone can afford appropriate healthcare. Health insurance providers bear the full or partial treatment costs for their insurees. All employees have health insurance – either under a statutory health insurance scheme or provided by a private health insurance company.
Statutory health insurance (GKV)
Statutory health insurance is broken down into compulsory and voluntary insurance. The statutory health insurance schemes also cover family members free of charge (family insurance).
Who is subject to compulsory insurance?
- All employees (white-collar and blue-collar) and trainees who receive payments for their vocational training
- Recipients of unemployment benefits (ALG/ALG II)
- Farmers and their family members who also work on the farm
- Artists and publicists
- Young people in special youth welfare institutions
- Persons with special needs, who work in recognized workshops, for example
- Students at state or state-approved colleges (for max. 14 semesters, or until they are 30 at the latest)
- Pensioners and pension claimants if a certain pre-insurance time has elapsed
- Persons without other health insurance cover if they are eligible for statutory health insurance
Compulsory insurance requires membership in a statutory health insurance scheme, for which contributions must be paid. The contributions are calculated based on specific income which is subject to contributions (e.g. wages, pension), up to a contribution assessment ceiling of € 3,937.50 per month in 2013.
In the event of an illness, the employer shall continue paying wages in the first six weeks. If the illness lasts more than six weeks, the health insurance company pays the employee after the first six weeks. The basic insurance cover under statutory health insurance covers the following services:
- Out-patient medical treatment, for example in medical practices
- Dental care
- Medication, remedies and aids
- In-patient stays and treatments, for example in hospitals
- Medically-necessary rehabilitation measures
- Services for pregnant women before, during and after birth
Family members are co-insured by statutory health insurance schemes. Spouses, registered partners and children (including foster children, step-children and grandchildren) of the insuree can be co-insured under statutory health insurance provided they
- reside or have a habitual abode in Germany
- are not subject to compulsory insurance or are voluntarily insured themselves (exception: recipients of unemployment benefits (ALG II) or students up to a certain age limit)
- are not exempt from insurance or exempted from compulsory insurance and
- are not self-employed on a full-time basis
If only one parent has statutory health insurance, and the income of the other parent exceeds the compulsory insurance threshold and is exceeds that of the parent with statutory health insurance on a regular basis, the children cannot be co-insured free of charge.
They are free to choose their health insurance provider. The health insurance scheme you join does not depend on your profession or industry. Health insurance contributions are deducted directly from your wages. If your monthly wage exceeds the assessment ceiling (in 2012 this was € 4,237.50 gross), you do not have to remain in the statutory health insurance scheme and can join a private health insurance scheme.
The conditions and the extent of the services which the statutory health insurance schemes provide are legally specified and therefore identical for all health insurance companies. For some services (for example health promotion, home help), the individual health insurance companies offer different scopes of services based on their by-laws.
Private Health Insurance (PKV)
In general, anyone can take out private health insurance with the relevant insurance companies. If the insuree is not covered by statutory health insurance, full insurance is possible. There are also private supplementary insurance policies to add to the cover provided by statutory health insurance schemes (e.g. spectacles, treatment by senior consultant, dental prostheses).
The contributions to private health insurance schemes are calculated based on risk factors (e.g. age, pre-existing conditions), not income. By contrast to the statutory health insurance companies, private health insurance providers can refuse to insure specific individuals, or impose risk surcharges.
However, persons without health insurance cover who are eligible for private health insurance (in particular the self-employed), are entitled to receive access to private health insurance at a “standard rate”. They are accepted without risk evaluation and risk surcharges. The standard rate guarantees their entitlement to medical healthcare and covers services comparable with statutory health insurance.
The electronic health care card
Everybody who is insured with a statutory health insurance company receives an electronic healthcare card bearing their name, date of birth, a photograph, the insurance number and insurance status. It serves as evidence of insurance cover for physicians and other service providers, and must therefore be presented every time you visit a doctor, so that the physician in question can bill the insurance company for your treatment. As a result, the patient does pay for treatment themselves in the medical practice or hospital. The healthcare card is valid in all 27 EU countries as well as Iceland, Lichtenstein, Norway and Switzerland. That means that if you become ill in these countries while vacationing or on a business trip, you can present the healthcare card to receive access to local medical services. We recommend that you contact your health insurance company in good time before travelling abroad for information on what to do in an emergency.
In Germany, you have free choice of physician. That means you can consult any doctor of your own choosing. Generally, your first port of call will be your family physician.
If you are looking for a family physician or specialist, the following tips may be helpful:
- Check the website of your city/town.
- The Bertelsmann Foundation's White List lists medical practitioners.
- The Doctors' Associations of Baden Wuerttemberg (KVBW) offer you a detailed search function for medical practitioners in your region (only available in German).
- Check the telephone directory or the Yellow Pages under Physicians (Ärzte).
- The British Embassy's website provides an overview of doctors in various regions of Germany.
When you have chosen a family physician, the best thing to do is to call the practice and make an appointment. Family physicians examine you, provide information on vaccines and many other things, and, if necessary, transfer you to a specialist or hospital. Only in emergencies should you go directly to a hospital without a transfer.
We recommend that you start looking for a family physician before you become ill.In general, the costs of consulting a physician are billed directly to your health insurance provider if you are covered by statutory health insurance. That means that the invoice is sent to the health insurance provider, not to you.
If you need medical treatment outside the office hours of your medical practice, you can dial 116 117 for the medical on-call service anywhere in Germany. In emergencies – i.e. potentially fatal situations – you should dial the emergency number 112.
Most medical practitioners are closed on Wednesday, either for half of the day or the entire day.
In Germany, medication is only available in pharmacies. Pharmacies can be identified by their signs which bear a large red A.
If you need medication, there are two ways to obtain it. The first is to visit your physician, who will give you a prescription. You then take this prescription to a pharmacy where you receive your medication. You only have to pay part of the costs for medication which can only be purchased with a prescription; the remainder is paid by your health insurance provider. The second way is to go straight to the pharmacy, where you can buy all freely available medication (i.e. medication for which prescriptions are not required). You have to pay the full price yourself.
Many people from other countries consider the prices of medication in Germany relatively expensive.
If you need in-patient treatment, you are entitled to be admitted to a suitable hospital, which is obligated to admit and treat you in accordance with its purpose and capabilities. Timely medical aid must be guaranteed. All hospital patients are entitled to the care they need based on the type and severity of their illness.
The hospital where you are to be treated is generally named by your physician on the hospital transfer documents. If you choose a different hospital to that in your physician's hospital transfer documents without a compelling reason, you could be billed for the resulting additional costs in full or in part.
Even if the hospital is full, it must temporarily admit patients who require immediate admission and care which cannot be guaranteed by another suitable hospital. If necessary, it will arrange to relocate patients.
In addition to general hospital services, hospitals can offer other treatments as elective services. They must not adversely affect the general hospital services. Admission and treatment of patients must not depend on whether they choose to avail of elective services.
As with all medical services covered by statutory health insurance, you have to pay a supplement for a hospital stay.
If you have private health insurance, these costs may be covered by a per diem sickness allowance.
While in hospital, you should also ensure that your rights as a patient are upheld. For example, it is particularly important that patients are fully informed before an operation. No operations may be carried out unless the patient is informed about the procedure and consents to it beforehand.
When you are admitted to hospital, you generally receive a printed list of everything you should bear in mind while in hospital. Many hospitals also publish these instructions on their own websites. Advice is also available from health insurance providers' websites.
In the event of an emergency, you have two options:
1. If the incident is serious, particularly if there is a danger to life, call the free emergency number 112. This telephone number applies everywhere in Germany. An ambulance will reach you within 15 minutes at the latest.
2. Otherwise, you can drive directly to a hospital's emergency room. The emergency rooms are open 24 hours a day.
At weekends, on public holidays or at night, the medical on-call services in hospitals, on-call medical practitioners or pharmacies in your area will help you. Many daily newspapers list the physicians and pharmacies providing on-call emergency services each day.
- Emergency response physicians and fire department 112
- Police 110
- Medical on-call service 116 117
- German Red Cross patient transport 192 22
- Emergency pharmacy service
There are no compulsory vaccinations in Germany, but some vaccinations are recommended, and the costs for these vaccinations are covered by health insurance companies. To find out which vaccinations are covered, you can contact the German Federal Centre for Health Education (BZgA) or consult your physician. A vaccination certificate documents the illnesses you have been vaccinated against. In addition to this, there are many preventive check-ups, some of which are legally recommended. There are the U1-U9 check-ups for infants and children, which help identify and treat developmental problems and illnesses as early as possible. There are also many preventive check-ups and early screening tests for adults, such as the skin cancer screening or dental check-ups.
Many health insurance companies offer bonuses if you undergo regular preventive check-ups.