American and German Health Care Compared

The American public-affairs documentary series Frontline just broadcast a show comparing the American health care system with 5 other healthcare systems from around the world, Germany included.  The entire show is available free online, so if you want to see the segment on Germany, visit this website and click on the third segment.  I haven’t watched it yet, but I’ll get back with comments when I have.

UPDATE: I watched the segment.  It’s hosted by T.R. Reid, an American journalist who’s written a few books about The Foreign Countries (Europe and Asia).  As you can see, he’s a pretty relaxed guy.  He wants to tell stories, not deliver detailed statistics that would bore viewers.  The segment seemed largely accurate to me, with three minor caveats. 

  1. You generally do get to keep your health insurance if you lose your job, but that only happens automatically for some people; for others, doing so can involve a lot of complex paperwork (g).  And, in any case, you’ll have to formally apply for unemployment benefits to maintain your claim to health insurance.  So it’s not quite as seamless as it may appear.
  2. Reid interviews Karl Lauterbach, who is described as an "expert" on the German health care system.  However, Reid doesn’t mention that Lauterbach is a member of the SPD (g), and thus has a partisan perspective.  Nevertheless, I found Lauterbach’s description of the system’s basic philosophy and operation accurate.
  3. Reid doesn’t mention the differences between private and public health insurance.  German doctors protest that they treat both classes of patients equally, but some studies indicate that private patients get faster appointments and more time with the doctor.

Now, for what it’s worth, my personal experiences.  I’ve been covered by both private and public health plans, and haven’t noticed any difference in coverage or the eagerness of doctors to treat me.  In fact, the public plan’s easier to manage, because you never see a doctor bill.  If you’re privately insured, you have to pay for your treatment up-front, and then seek compensation from the insurance provider.  However, if you don’t send in many bills during a particular year, the private plans give you a fat premium rebate.

As in England, your first job is to establish a relationship with a GP.  If you get a good one (like mine), you never have to wait more than a week for an appointment, and he or she will squeeze you in if you have an urgent problem.  If you need specialist treatment, you get a referral from your GP.  I’ve never had a problem getting an appointment with a specialist within one or two weeks.  Emergency rooms in big-city hospitals are much less full and chaotic than they are in the U.S., but you’ll still have to wait hours for non-emergency treatment.  If you’re publicly insured, all you do is present your "chip card" (which has your basic data on it) everywhere, and sign a few papers.  You have to pay a co-payment of 10 euro every quarter. 

German doctors are more businesslike than their American counterparts; they generally get straight to the point and don’t sugarcoat test results or pretend to be your friend.  If they want to do a test on you, they’ll issue brisk orders: "OK, undress and get on the gurney, please.  Turn to the right.  Now, this may feel a bit uncomfortable.  Hmm…  Okay, everything looks fine.  You can get dressed now.  Have a nice day!"  Bing-bang-boom.  Most doctors’ offices are run very efficiently, and you won’t spend a minute more talking to the doctor than necessary, although they will always answer your questions, and I’ve never been denied a referral for anything.

Like the American Reid interviews in the segment, I’m satisfied with the healthcare I receive in Germany.  The best thing about it, from my perspective, you’ll never lose it, and never have to worry about it.  It’s always there in the background, following you from place to place, job to job.

13 thoughts on “American and German Health Care Compared

  1. That’s great that American public-affairs documentary series is now online. I personally would like to watch it and even share it with my friends. It would be good to know more about the health conditions.

    Like

  2. Hi Andrew,

    Just to say I absolutely love your blog.

    Something about Germany that struck me once again watching the interview with Lauterbach was just how many PhDs (or even Prof Dr’s) there are in German public life. Lauterbach’s a professor, and frankly he looks and sounds like one (I mean this as a compliment). Yet he holds elected office. Somehow, here in the UK, and I think in the US too, it’s less common for someone who *seems* like a wonk to win public approval. Ditto senior corporate positions: it seems quite a few senior people at German firms are PhDs, but this is very rare in the English-speaking world, even at firms whose business is related to engineering or technology.

    Does this accord with what you’ve seen, and can you shed any light on differing perceptions of experts?

    Sam.

    Like

  3. Though I haven’t had much experience with the German health care system, I’d have to say I’ve been generally impressed. A few years ago, after taking a small tumble down the stairs to the U-Bahn in Berlin, I ended up with a broken foot. At my hotel, I called the doctor, and one came within an hour. That was the first major surprise, considering the rarity of house calls in the US these days.

    After going to the hospital emergency room, the whole process, from entry to exam to X-ray to plaster cast, lasted a total of four hours, and I was out the door.

    The final bill, which I ended up paying in full, must have been at least half of what it would have cost in the US.

    Germany must be doing something right.

    Speaking of insurance, though, does anyone know how this works with regard to Heilpraktiker, which seem to be much more plentiful than in the states?

    Like

  4. Huh – the report seems to imply that if you’re in the legal (“gesetzlich”) system, you never see a doctor’s bill. That’s a bit unrealistic. You can hardly get decent eyeglasses without paying quite a nice amount of money yourself, for example (it used to be a bit better – “Und mein Papi hat keinen Pfennig dazubezahlt” – but Kassengestell has never been a compliment). And if you can possibly afford it, you usually don’t want to take the cheapest filling material your dentist has to offer.

    @Christian:

    Speaking of insurance, though, does anyone know how this works with regard to Heilpraktiker, which seem to be much more plentiful than in the states?

    If you’re privately insured, they’ll usually be covered to some extent in your plan; if you’re legally insured, you need a supplementary insurance (example). This does not apply to psychotherapists though, who are treated like medical doctors.

    Like

  5. That was a bit over the top, Paul. I suspect that the German system works better thsn the US one does because many fewer resources are used on paperwork and excluding people from the system – or rather certain parts of the system.

    Private care in the UK is very expensive, and the NHS has it’s shortcomings, it is often extremely slow. There are ways to ‘game’ the NHS, but another dodge is to go to another country and pay for good quality and reasonably priced private care elsewhere. Germany is one of the places where UK people go for this kind of thing. India, France, and eastern europe are other good choices. So Germany may really be better than the US, at least for those of us not made of money.

    Like

  6. That was a bit over the top, Paul. I suspect that the German system works better thsn the US one does because many fewer resources are used on paperwork and excluding people from the system – or rather certain parts of the system.

    Private care in the UK is very expensive, and the NHS has it’s shortcomings, it is often extremely slow. There are ways to ‘game’ the NHS, but another dodge is to go to another country and pay for good quality and reasonably priced private care elsewhere. Germany is one of the places where UK people go for this kind of thing. India, France, and eastern europe are other good choices. So Germany may really be better than the US, at least for those of us not made of money.

    Like

  7. That was a bit over the top, Paul. I suspect that the German system works better thsn the US one does because many fewer resources are used on paperwork and excluding people from the system – or rather certain parts of the system.

    Private care in the UK is very expensive, and the NHS has it’s shortcomings, it is often extremely slow. There are ways to ‘game’ the NHS, but another dodge is to go to another country and pay for good quality and reasonably priced private care elsewhere. Germany is one of the places where UK people go for this kind of thing. India, France, and eastern europe are other good choices. So Germany may really be better than the US, at least for those of us not made of money.

    Like

  8. Don, as sarcasm it was meant to be over the top.

    I do think that the German health system is in some ways superior to the American.

    Nonetheless, it does have severe deficiencies. German doctors are underpaid and overworked, burdened with paperwork and chores like taking blood that any nurse could do. I know a few German doctors, personally and professionally, and in my view they are heroic to be doing what they are doing. They are really not appreciated enough and their working conditions are a national scandal.

    Many doctors are departing Germany for the U.S., Canada, England, and Norway among others, or going to work for pharmaceutical firms.

    The shortage is already acute and getting worse.

    As for being “over the top”: I really shouldn’t indulge myself. Mr. Hammel deserves better. But I have fallen into a dialectical relationship to our Host. He has solved the issue (and it is an issue, conscious or unconscious) of being an American in Germany in his way and I am still working out my way and perhaps the two ways will converge at some point, if I am not kicked off this blog before then.

    Meanwhile, I can enjoy the nattering wit of Mr. Möhling.

    Like

  9. I’ve been living here in Bloomington for seven years now and with all fairness, the health care here is great. The government has been providing the community better health care services than before. We have great and friendly doctors, nurses and dentists. And as a matter of fact, I just went to Bloomington dentist‘s office for the first time, and they provided me with excellent dental care.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s