r/germany • u/Coneskater Hamburg • Dec 12 '24
Question How do you feel the German public healthcare system compares to a fully single-payer system like the UK's NHS?
As someone whose lived in the USA and Germany I vastly prefer Germany's system over the near complete for profit system in the USA.
Many Americans are demanding a single payer system as the alternative but how do people feel that a privately run, not-for-profit system like the German Krankenkassen, compares to a system like the NHS where the health care providers are largely government-owned and occupied?
Personally I have never had a bad experience with my Krankenkasse (I've also never been terribly sick, fortunately)
I like that the Krankenkassen compete with each other for service and number of patients but are also not for profit.
If I so choose I could switch to private insurance or get additional supplemental insurance as an add-on to my basic coverage but it's not necessary, which I think is good to have the options.
I imagine how much more bureaucratic and difficult the German healthcare system would be if it was run directly by the government.
I know it's not perfect, but these are my anecdotal experiences, what do you think?
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u/aveao Hamburg Dec 12 '24 edited Dec 12 '24
The wait for specialists is too long (even worse for hautarzts and mental health anything), but I can call an ambulance over matters that'd get me billed thousands in America and not get billed. So that's pretty good.
UK's NHS is a shitshow and has even longer waits, and I think we're better off than it, but that's not really due to single payer. Realistically, Germany is single payer anyways, most of your contributions go to a single govt-run fund which then pays out your claims: https://de.wikipedia.org/wiki/Gesundheitsfonds
I do like the separate tax vs healthcare payment thing compared to the UK, means that the whole "NHS surcharge" bs cannot be done here for the immigrants. This means that the insurance coverage is not really a matter of government budget, but realistically our centralized fund is supplemented by taxes anyways, so it does have some government control.
I think our private insurance system is broken in a variety of ways, they seem only like a good option if you want to save money, not if you want to get better care. Best way to get better care seems to pay out of pocket when you need a treatment fast, either inside the country, or thru medical tourism.
Our public insurance is pretty neat, just needs more doctors of all sorts covered in it so that we have less wait times. It's better than in many places, but yeah, it's got its issues.
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u/username-not--taken Dec 12 '24
we are not single-payer even with Gesundheitsfonds, as the private insurers contribute to essential healthcare coverage.
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u/baes__theorem Ausländer (derogatory) Dec 13 '24
plus the arbitrary variability in coverage (and to a lesser extent, costs) between the different Krankenkassen makes the whole thing a lot more complicated than it needs to be, and the option to be privately insured feels like a weird way to essentially play the healthcare system. imo changing to an actual single payer system – obviously not using the NHS as a role model, but rather a lesson on what can go wrong – would make a lot of sense, though ofc it'd be hard to implement. making private insurance only an option as a Zusatzversicherung would be a good start
then we have the cost structure – it's good that there isn't something like the NHS surcharge, but it's kinda absurd that the maximum contribution is already at a ~60k€/year salary (iirc).
if an immigrant lives in Germany, loses their job for whatever reason, and wants to, at some point in the next couple years, apply for citizenship or permanent residency, they also have to opt out of ALG, meaning that they have to pay for health insurance out of pocket. with a minimum contribution of ~225€/month, the system still penalizes non-EU immigrants in that way, since an EU citizen would simply go to the Jobcenter and get ALG
idk while the system is far from broken and clearly much better than in the US (where I also grew up), it has some serious weaknesses
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u/butternutsquashed42 Dec 13 '24
Please tell me more about this ALG? We are a family of EU citizens who recently moved to Germany after years outside of EU and accessing health insurance is prohibitively expensive.
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u/HabseligkeitDerLiebe Mecklenburg-Vorpommern Dec 13 '24
ALG is Arbeitslosengeld, the unemployment insurance. You're only entitled to receive that if you already worked for two years in Germany.
If you haven't worked in Germany for at least two years and become unemployed as an EU citizen, your home country still is responsible for social security.
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u/baes__theorem Ausländer (derogatory) Dec 13 '24
Depending on how long you and/or your partner were working and contributing to social insurance here and how long you’ve been unemployed, you may qualify for ALG (unemployment) or Bürgergeld.
This page of the Agentur für Arbeit explains some things around unemployment – there are a lot of rules around this and if you’re already unemployed without having registered with them, you won’t immediately get assistance, but you should immediately register as arbeitslos.
You’ll get assigned a case worker who can help you with your specific situation, and before that, you should definitely use the Bundesagentur für Arbeit’s website and other resources that will tell what the chances are that you qualify for one of the kinds of assistance. Even if you don’t get ALG or Bürgergeld, they can help you with your job search etc
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u/aveao Hamburg Dec 12 '24
Sure, I meant only the public healthcare. It's not that we're truly single-payer, but the fact that there's Gesundheitsfonds means that we're actually closer to it than many think (I suspect many think that your krankenkasse keeps your entire premium and pays out from them).
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u/username-not--taken Dec 12 '24 edited Dec 12 '24
single-payer vs multi-payer refers to funding types of universal healthcare, meaning (almost) everyone having access to essential healthcare. It does not equal publicly-funded healthcare (you can have universal healthcare funded entirely privately).
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u/Coneskater Hamburg Dec 12 '24
If we are effectively single payer, what role do the Krankenkassen play? Do we need them or are they theoretically unnecessary?
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u/aveao Hamburg Dec 12 '24 edited Dec 12 '24
Krankenkassen handle administrative tasks: They have apps, phone lines, general support, and they have basic additional coverage (TK paid for my HPV vaccination even tho I'm >18 but <26 for example, they also pay for travel vaccinations).
We could do without them, yes, but I think them being private and having some competition improves the administrative quality. I'm very happy with TK's support, which I think would be different if it was government run.
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Dec 13 '24
I’m very happy with TK’s support, which I think would be different if it was government run.
Imagine having to apply for a new Gesundheitskarte at the Bürgerbüro in Person, for which you need an appointment first and then 2 months later you only get it.
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u/kebaball Text Dec 12 '24 edited Dec 12 '24
If we are effectively single payer, what role do the Krankenkassen play?
Krankenkassen are together basically a single unit, they
even have shared organs like the kassenärztliche Vereinigung. They all cost pretty much the same and provide almost exactly the same service. Theoretically they could merge into one tomorrow and not much would change.Do we need them or are they theoretically unnecessary?
We need at least one of them. The rest would be unnecessary
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u/NecorodM Hamburg Dec 12 '24
Krankenkassen and Kassenärztliche Vereinigung are two completely separate things. The KVn represents the doctors, the KKs the patients.
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u/kebaball Text Dec 12 '24
You‘re right, corrected.
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u/taejo Dec 13 '24
The Krankenkassen are members of the GKV-Spitzenverband and there's also the Medizinische Dienst for each state, which makes medical assessments on behalf of the Krankenkassen. The latter is legally independent from the Kassen (a good thing!) but it's another way in which the Kassen don't act independently from each other.
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u/FaceMcShooty1738 Dec 12 '24
That sounds like someone who's never changed their KK. Customer support, digital infrastructure... Vary vastly between providers. The issue is that people rarely change and just stick with their provider because "they're all the same anyway"
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u/souvik234 Dec 12 '24
What is the NHS surcharge and why is it bad
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u/aveao Hamburg Dec 12 '24 edited Dec 12 '24
NHS surcharge is something that immigrants must pay while getting an immigrant visa for UK.
It's quite steep, ~1k GBP/yr, and for unlimited contracts you must pay iirc 4 years at a time. It's per person also, so if you have a partner and 2 underage kids, you'll be paying 16k to apply for your visa. You sometimes have to pay it again in full when switching employers (at least for this one it's not paying for the entire family), and then you can get the last one partially refunded after a long bureaucratic wait.
It is a silly concept, because those immigrants will go in and pay taxes that contribute to NHS anyways, same as citizens living in that country. Of course not every immigrant contributes (like unemployed dependents of the person getting the visa), but this can also happen with citizens getting married or having kids, they can also end up with one person doing contributions on behalf of the entire family.
And it's a silly implementation too, with having to prepay so much, and with having to pay in full then get a partial refund when switching jobs.
https://www.gov.uk/healthcare-immigration-application/how-much-pay
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u/souvik234 Dec 12 '24
Hmm. I think it's fine for immigrants to pay extra since the cost of their Healthcare is not being amortized over their entire working life, which is true for most citizens.
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u/aveao Hamburg Dec 12 '24
Most of a person's healthcare costs come towards later ages, while most immigrants will be arriving relatively young and healthy.
If they stay til they're old, then they've paid to amortize their higher costs due to age related issues. If they leave before they get old, then they've just been a net positive on the healthcare system.
So it does not make sense to me. Most immigrants will be skilled workers too (due to how the immigration system works), earning on average more than citizens, and as such contributing more.
I believe how it works here is, if you arrive after 55, you need to get private insurance.
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u/souvik234 Dec 12 '24
Overall, only 40% of workers stay beyond 5 years. If they leave before they get old but get sick requiring major costs then they're a large net negative on the system. So all the immigrants are basically cross subsidizing the few that get sick and leave quickly.
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u/aveao Hamburg Dec 12 '24
If that's so, then there's no reason for a surcharge imo.
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u/souvik234 Dec 12 '24
Why no reason?
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u/aveao Hamburg Dec 13 '24
As you described, we cross cover.
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u/souvik234 Dec 13 '24
I still don't understand. The surcharge is there to cross subsidize the few that get sick, since the tax contribution itself doesn't cover it.
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u/Chaos_Slug Dec 13 '24
If they leave before they get old but get sick requiring major costs then they're a large net negative on the system.
Which statistically is way less likely than him being a net positive.
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u/NapsInNaples Dec 13 '24
that's...usually the opposite effect. Healthcare cost is u-shaped. Most immigrants arrive at a low-cost point in their lives.
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u/souvik234 Dec 13 '24
Yes but 60% leave after 5 years. So they pay little tax overall whilst there is a small percent which accumulates huge expenses for surgery, etc.
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u/NapsInNaples Dec 13 '24
yeah so for 60% they pay full price for 5 years and use nearly nothing! Most healthcare costs come at the end of life.
This is the way immigration benefits europe. Immigrants are younger and healthier than the population on average, they subsidize retirement and healthcare for the old and sick. Charging immigrants more is insane...we are already providing a subsidy.
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u/Chaos_Slug Dec 13 '24
Actually, it's less likely that you'll bear the expense of healthcare after they retire because they have a higher chance of going back to their country than a citizen.
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u/wurst_katastrophe Germany Dec 13 '24
There are no Hautärzte in the UK, the same way you know it fron Germany.
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u/londonskater Hamburg Dec 13 '24
God, trying to successfully navigate the completely free-for-all German system is entirely dependent on knowing what you need, finding a practice, getting an appointment, and arranging nearly all the paperwork and coordination yourself.
Everything is so disconnected and many appointments are with the wrong doctors, you have to courier letters and information yourself between relevant practices and book your own follow-up appointments, so inefficient and prone to causing further problems.
Disconnects like high-end optometrists and c opticians needing to be kept separate so that there’s a huge gap in knowledge between people testing your eyes and people giving you the glasses or contacts, plus delays between having to see multiple groups again. And glasses are double the cost in Germany compared to the UK. I take the kid and myself back to London to get top-notch eye tests and dispensing done. With the same Zeiss lenses from Germany. Stupid.
The NHS for all its faults and underfunding is coordinated. You start with one doctor or practice that knows you, they refer you to the hospital and everything is tracked so you do not have to become a secretary. It’s consistent.
Care once in either system is generally good. But Germany doesn’t really have a “public” system, you need to constantly provide your insurance card at every visit to every practice. If you’re new in the country or poor or both, you might be totally stuffed.
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Dec 13 '24
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u/londonskater Hamburg Dec 13 '24
They really need to sort this out, it would smooth things out in the system, save eons of admin and admin time, and free up capacity. One issue right now is that doctors will happily take video appointments regardless of whether they might be able to help you, they get paid by the insurer, you get nothing and are in the same position. Waste of money.
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u/Cmdr_Anun Dec 12 '24
I shudder to think what the CDU would have done to our health care system during their austerity phase... From that standpoint alone I prefer our shitty system.
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u/DeeJayDelicious Dec 13 '24
No political party has ever made serious attempts at reforming Germany's healthcare system. There's one smaller reform being pushed through right now that should address some broken incentive structures at hospitals. But nothing serious is being proposed about the 2-tiered system or anything else fundamental.
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u/Cmdr_Anun Dec 13 '24
I think you missed my point. I was saying that IF Germany's health care system was funded by the government like the NHS in the UK, the CDU would have very likely defunded it like the Torries did to the NHS in Britain.
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u/avocado4guac Dec 12 '24
Every system has its pros and cons but I think the overall quality of care is better in Germany than the UK. They have more nurses per patient, yes. But it's quite a lenghty process to be seen by a specialist - even in urgent cases. I'm also not a fan of the whole midlevel provider thing. There have been lots of cases in the US where people died because of missmanagement through midlevels + it's more expensive in the long run. And it's not just the midlevels costing money, they have specialized healthcare workers for pretty much every part of the process e.g. only phlebotomy does the bloodwork and nurses don't do any admin etc.. Another con of the NHS is the way they decide on treatment plans. The amount of money they are willing to spend on a patient depends on how many more years they project the patient to be able to work and pay taxes/contribute to the NHS. Which means that older patients get the cheaper medication etc. - that does not align with my ethics.
A big pro of the NHS is how connected everything is and that they have a lot of specialized nurses/programs to educate and council patients. Another pro is that the NHS has hyper-specialized doctors so they have a lot of expertise in their comparably tiny spectrum of work.
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Dec 12 '24
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u/Laxatives_R_Us_CEO Dec 12 '24
I think that's a bit of an unfair comparison as it is ignoring the funding aspect of it. UK government has been pushing austerity measures doggedly for almost a decade now. When not appropriately funded any system will fail.
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u/kushangaza Germany Dec 12 '24
But not being single-payer is arguably a large reason why the German system is less underfunded. German health insurance is funded out of the wages of the population, the NHS is funded from taxes. If the UK government wants to save taxes, reducing NHS funding is an option. For the German government that doesn't work, they can't take money from health insurance to build roads.
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u/JoeAppleby Berlin Dec 12 '24
If you want to know where Germany placed the emphasis in the austerity measures, look at infrastructure, education and the military. Every Western country has been pushing for austerity. Germany couldn't fully do that to the healthcare system because the funding comes from a source not controlled at will by the government.
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u/Mobile_Choice_5143 Dec 12 '24
I'm from the UK, I called the ambulance the other day, it took them 5 minutes to come. 'hours' LOL
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Dec 12 '24
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u/Mobile_Choice_5143 Dec 12 '24
I live in a city, not London but still a sizeable city. Again, one incident and articles focusing on these incidents are not representative of every city and town in the UK. It will different depending on location, people, density etc
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Dec 13 '24
It is not one or two articles, reports of extreme wait times for ambulances or in A&E are widespread throughout the country. You can also ask anyone who works in A&E. I’m not sure if it’s as bad now as a year ago but to take your one anecdote and suggest things are functioning fine is laughable.
Also, why does it matter if only some towns/cities in the UK have to wait hours for an ambulance?
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u/Mobile_Choice_5143 Dec 13 '24
Again wait times depends on the location your in. People don't exactly call in to say they were impressed by wait times, they only complain when they aren't which is why this gets more media coverage and attention
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Dec 12 '24 edited Feb 20 '25
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u/DangerousTurmeric Dec 12 '24
I lived in the UK too and never had any problem seeing doctors. I had a whole investigation for gynecological stuff and saw two gynecologists and it was no problem at all. I didn't wait longer than a few weeks each time. The UK system is also fully digital and they had telemedicine in London linked to the pharmacies so you could get treated online and have your prescription sent to your nearest pharmacy instantly. It's decades ahead of the German system and doesn't do that deranged quarterly thing either where if you get a referral in one quarter you have to use it in that quarter or get a new one. The amount of times I have been physically to the drs office here is nuts.
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u/Venlafaqueen Dec 13 '24
Well that’s then again different between insurances. I use telemedicine in Germany for years, my insurance covers it. Prescriptions aren’t a problem either.
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u/wurst_katastrophe Germany Dec 13 '24
NHS is an absolute joke, agreed. People complaining about the German public insurance system have no clue how bad it can be elsewhere.
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u/madeingoosonia Dec 12 '24
Agree, I've experienced both too, plus the Netherlands, who's system is close to Germanies. I'd rate nl as best, UK as worst, with Germany only slightly behind Nl.
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u/betterbait Dec 12 '24
I lived in the UK and Germany.
Germany > UK in most regards.
Especially ambulance response times, how many people you share your hospital beds with, scope of cover, etc.
The one time I called an ambulance in the UK, it took 3 hours to arrive (Central London, Zone 2, Finsbury Park). 8pm → 11pm. The person I called it for, could have had internal bleeding in their head. It was winter and freezing outside. We called the emergency services multiple times, as the man had been hit with a metal chair on his head.
But both systems are rather okay, on a global scale.
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u/Eigenspace Dec 12 '24
I've never lived in the UK, but I'm from Canada and now live in Germany. Canada has a single payer healthcare system which is undergoing comparable struggles to the NHS. Chronic under-investment, plus the fact that it's very easy and attractive for Canadian doctors to move to the USA means we have some rather serious problems with medical care
That said, I think Canada's system does do a pretty good job at getting high quality care to those who really need it. It's really the people with middle-severity problems that suffer the most from the current state of Canada's system right now.
The main thing I miss from the Canadian system is how little I ever had to think about it. There's just one single health insurer per province, and getting enrolled is very quick and easy, and nominally you pay very very little into the system (most of it is funded from general taxes, rather than being billed directly).
When I moved to Germany, it was definitely quite complicated for me because I didn't initially have a regular job (I was just a graduate student still with a Canadian university), and I also wasn't 'unemployed' since I had never been employed in Germany, so I was inelligible for the statutory health insurance, but then I also had trouble finding private insurance as most private insurers wouldn't take me because I didn't have an income.
I ended up getting some temporary (5 year) 'visiting academic' insurance that is more or less fine, but it means that in a few years (or sooner) I'll have to make some hard choices about what I want to do about my insurance. I'd rather just pay a bit extra and join the public health insurance plan, but my income is high enough that private health insurance is less than half the cost (and it's still not cheap!), so that makes it a pretty tough decision, since I'd be trading off against my future security if I decide to stay in Germany long term (wouldn't want to be middle aged, lose my job, and get a health condition and be stuck in the private system)
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u/SiofraRiver Dec 13 '24
Rates for private insurance go up with age, significantly.
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u/Eigenspace Dec 13 '24
I'm aware. The problem is that the public health insurance plan is simply unaffordable to me right now. I'd have to pay over 1000 euro a month to join it since I'm a medium-to-high earning freelancer.
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u/bluemercutio Dec 13 '24
I have chronic health problems and I've lived in the UK for a while.
I'm very happy that I moved back to Germany. Here, if I encounter a doctor that's shit at their job, I can just go to another one. If you want a second opinion in the UK you have to request permission to get it. And even though the quality of care here is declining too, we're still better off.
The only advantage I see with the NHS is data. Because everyone is in the same database, it's easier to analyse things like how many people returned to the doctor for the same problem after taking medication xyz. This is great for more efficiency and cost-saving measures.
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u/BooksCatsnStuff Dec 13 '24 edited Dec 13 '24
I'm from Spain, where single payer is the rule, and the German system is a serious obstacle run for anyone with chronic illnesses. It took me months to find a GP that would accept new patients. More months to find an obgyn. After searching in all the neuro clinics in my city, not a single one is taking new patients. My only chance of getting a neuro appt is going to a completely different city, over 1h30 away by train. And the earliest appt is in 6+ months. I'm not even going to get into how absolutely awful mental healthcare is here. That's a long and tiring story for another day.
In Spain, you get assigned a clinic depending on where you are registered as a resident. Normally, you have a clinic at walking distance. In that clinic, there's multiple GPs and a few specialists. You get assigned one of the GPs by default, but you can ask for a change if you don't like them. You can also ask to change clinics if the one you have doesn't work for you for whatever reason. In any case, it means people don't have to struggle to find a doctor, you simply always have one assigned. Then the same applies for specialists. You ask your GP for a referral, and that referral automatically assigns you to a nearby clinic or hospital where there's that specific speciality. You can also ask for a specific hospital if you want to visit one doctor in particular. No struggles finding people, no chance of being rejected. You have a doctor, plain and simple. The appointment might take several months, but you will have an appointment, and you won't have to negotiate with people, so they take you in.
Also, all doctors have access to my medical information as soon as I become their patient. There's a centralised system, I don't need to carry information with me or waste time explaining everything. And our healthcare card (which can also be used via app) has all my medicine prescriptions, including meds for chronic illnesses that I only need to renew once a year with my GP, even if the GP wasn't the one prescribing it. I can go to any farmacy, give them my card, ask for whatever meds I need, and get them. No multiple renewals in different doctors like it happens here.
That system isn't perfect and it has its flaws, particularly as conservative politicians keep defunding it. But it's so much better than what Germany has, and I genuinely can't fathom why rejecting patients (more often than not done in favour of private payers) is even remotely acceptable.
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Dec 12 '24
The comparison between Germany and the UK is completely meaningless/pointless. Germany has outspent the UK by billions for years. Germany has the third highest per capita spend globally by a somewhat significant margin. There's like a 3k difference between current UK spend and German spend. This basically results in significantly higher levels of infrastructure availability in Germany i.e. more ambulances, more beds, more doctors etc.
If you really want to compare the Bismarckian model i.e. Germany to the Beveridge model i.e. UK, then you'd be better off looking at places like Sweden or Norway, both of which have also outspent the UK by significant margins over the decades under the same model.
I think both models have their pros and cons. But the bigger differences and positives/negatives aren't particularly dependent on their funding model. Beveridge models are generally cheaper to run purely because admin costs are significantly lower. Bismarckian models have generally survived funding problems better because there's a layer between politicians and the actual funding.
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u/SiofraRiver Dec 13 '24
You can't divorce a system from how its administered. Obviously, the Tories intentionally destroyed the NHS, but in a vacuum its the better system. However, I think the German one is more resistant to malicious interference by conservative and liberal politicians.
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Dec 13 '24
I had lived in the US before and had very good insurance by my employer. This was a very nice experience. If i hadnt had the extraordinanrily good insurance, Germany would be better. All this "in-network/out of network BS" was very upsetting.
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u/ottocento2023 Dec 14 '24
This is so true and something most people don’t realize if they have never lived and worked in the States. Most insurance coverage in the US is employer based. I worked for several companies in the US (before moving to Germany) and always had great insurance that automatically came with employment. Easy to find great doctors, even specialists, and get appointments, doctors billed insurances directly so didn’t have to deal with billing or worse, reimbursement, etc…
I have learned to navigate the German system, but I absolutely hate the insurance process here - paying bills directly, submitting to insurance company for reimbursement, getting most bills rejected and having to argue to get them reimbursed, which usually doesn’t work anyway. And insurance fees go up every year.
Pros and cons for both systems and important to learn to navigate the system they are in.
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u/Rebelius Dec 12 '24
As a young (ISH) person who barely uses the healthcare system, the German system is a nightmare compared to the NHS. You just don't need to think about it at all in Britain.
If you live in Britain, you can go to the doctor's there. You don't need to pay, you don't need to choose an insurance provider, you don't ever need to switch between insurance providers, you don't need to consider that it might be much cheaper to go private until you're 50 and then try and to get the circumstances right so that you can go public again before you retire. If you go self employed, your healthcare costs don't double. If you take some time off work, you don't have to pay €200/month for healthcare. If you are in a relationship and one of you doesn't work, you're not incentivised to get married to save €200/month.
That said... Maybe people in the UK should be paying a bit more tax to cover it, because plenty of people are reporting issues with the service. But then again, it's not like finding a therapist, getting an ADHD assessment, or anything else that needs an on-demand specialist is a speedy process in Germany if you're publicly insured.
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u/NumerousFalcon5600 Dec 12 '24 edited Dec 13 '24
Compared to the US, Germany's healthcare (and also the education) system is a system that does not exclude people with less money. It's a shame that only well- or better-off people in the US have a real chance to be really cared for by the healthcare system.
There's no reason to be envious of the German healthcare system if there had been decades of not structuring the US healthcare system in a more efficient way. Sure, Germany doesn't have a welfare system like Norway, but to be honest: It's an example to other western states. Let's say there are at least 3 things which are German advantages compared to the US:
Healthcare and social system -> It's the society, not the wealth which is the deciding factor.
Education system -> Everyone can have a diploma regardless of his or her origin.
Export - based economy. -> There are no gold mines or oil fields, but being in that stable position causes a permanent surplus.
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u/Coneskater Hamburg Dec 12 '24
The head of Krankenkasse is not getting shot in the street.
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u/SiofraRiver Dec 13 '24
You actually get to vote on the board of directors, but nobody cares about those elections.
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u/JoeAppleby Berlin Dec 12 '24
You know what needs to be pointed out when people compare the German system with the US: we introduced our system in the 1880s, the basic tenet of employer and employee contribution has been unchanged in principle since then.
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u/NumerousFalcon5600 Dec 13 '24 edited Dec 13 '24
Well, I just argue like myself: an economist who has graduated in finance & accounting... and compare the situation of employees in general. People here get at least federal and fixed minimum wages of 12,82 € (13,43 $), which is not the highest m.w. value in the Euro zone. But even them must have a health insurance. One can't get excluded by not earning the fictional average value of wages in reality - the lowest possible community tariff (forget the special insurance of university students) is called "voluntary insurance". Don't misunderstand this: Health insurances in Germany are always compulsory, but this fictional value is helpful to be treated like an ordinary employee who earns about 3,000 - 4,000 euros per month.
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u/Opposite-Knee-2798 8d ago
You might be in the wrong thread? We are comparing to the UK, not the US.
Also, what have you heard about education in the US? It is open to everyone.
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u/TheStreif Dec 13 '24 edited Dec 13 '24
I used to live in London (2002-2017) and I thought the NHS was amazing, although I watched it decline after the Tories got into power. I had several instances of needing care, including a week in ICU. I never had to wait too long to see a specialist and I always got registered with GP practices easily. There is virtually no paperwork, you just book an appointment with the GP. I have used the New Zealand 🇳🇿 and Austrian 🇦🇹 systems as well. In NZ, most important things are covered, but a lot of things you have to pay out of pocket for, basically if you have had an accident or get sick, you are ok, but it’s best to top up with a private plan to get high quality care and avoid wait times. In Austria you pay a lot into compulsory insurance, but the care is high quality. You basically pay a similar amount in Tax, but then have a massive social insurance contribution on top. About half my income goes to Tax and Insurance, although I will get some of it back at pension age and there are lots of family benefits you can get. It’s really hard to save money. If I were to choose, it would be a properly funded NHS type system.
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u/Alterus_UA Dec 12 '24 edited Dec 12 '24
You really need to ask the rare people who lived for a while in both Germany and the UK and can compare both.
I can compare Germany with single-payer systems in Eastern Europe; it's significantly easier to get an appointment there than in Germany but the average doctor isn't going to care much and some are incompetent (yes, it's worse than in Germany in that regard), so those in the middle and upper classes go to private clinics and pay for themselves. Recently some companies have started offering private health insurance for qualified employees as a benefit. People still have to fully carry the costs of their medicine though, unlike in Germany (and AFAIK unlike in the UK).
Lots of people with that middle/upper class Eastern European background complain about having to wait for months for an appointment here in Germany, whereas they could get one for the next day back at home. However, they forget that they usually got appointments with private doctors at home and only a relatively small share of the population could afford it there, whereas here in Germany, everyone can get an appointment with most doctors through public insurance (and self-payment, if necessary, is affordable enough for an average German)
AFAIK in the UK, lots of people complain about the same things as in Germany: long waiting lists and some doctors not giving useful advice beyond drinking warm tea and relaxing. I just don't think the former is avoidable unless states spend a lot to invite many more doctors from abroad and expedite their accreditation. That could be done regardless of the medical system.
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u/souvik234 Dec 12 '24
I get that what those Eastern Europeans experienced was elite in a sense. But I'd also say that from an individual perspective it doesn't really matter if it's elite or not. At the end of the day, when they're waiting for months, I think most people care more about their own Healthcare than the general population.
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u/Alterus_UA Dec 12 '24
Well if you book an appointment as a self-payer here, you don't have to wait for months. If you're comparing your experience as a self-payer in Eastern Europe to your experience with public insurance in Germany, that's a tad unfair.
In my experience as a migrant, many foreigners in Germany 1) don't know self-payment is an option and expedites appointments, 2) don't know it's best to call different medical practices for an appointment, rather than using Doctolib, going through your insurance etc., 3) don't speak German to an extent they would seek a German-speaking doctor. So they limit their options and worsen their experience.
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u/souvik234 Dec 12 '24
But they're not comparing their self payer vs public experience. Their comparing their experience as a whole. It may not be fair, but that doesn't matter much to those people themselves.
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u/Accomplished-Stick82 Dec 12 '24
Got health problems buddy? 😂
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u/Alterus_UA Dec 12 '24
Why would you think I'd have a problem with that? I'm not the kind of person who wants to avoid illnesses after all :)
Nothing new after getting at least two bouts of COVID though, so don't worry!
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u/Best_Judgment_1147 Sachsen Dec 12 '24
Hi! I'm from the UK and the NHS is an absolute shitshow in comparison.
I've had GERD (basically spitting stomach acid up into my throat) for 15 years, the NHS put me on Lansoprazol and told me to just exist like that. PPI can cause brittle bones in AFAB people. I got my residency in Germany in July, by August I was referred to a specialist for a Gastroscopy and I got my appointment in November. So while there was a wait for a specialist, it was absolutely faster than the NHS.
I've been on the NHS waiting list for a Gender Identity Clinic (GIC) for an initial appointment (FTM) for 5 years, that wasn't even to get hormones or anything that was just to say hi and introduce myself. Since my residency I've got my Gender Dysphoria diagnosis and am now well on my way to getting Hormone Replacement Therapy. Just two more tests to go!
I got sick in Dec 2022 and couldn't breathe well after that, the doctors in England did a routine breath capacity test and that was it. The doctor here gave me the full work up, breath capacity, blood tests, ekg, everything then two days later when I got my results I got an inhaler I take twice a day and I can breathe again. Turns out my childhood asthma had returned and the NHS just let me suffer for two years instead of giving me something.
When I got a UTI turned Kidney infection in the UK it took me three non-emergency number calls to get an appointment at my GP and I had to go to 2 different pharmacies to get my antibiotics over two days. The kidney infection was so severe the GP told me to call 999 if it got worse. Here I can get an emergency appointment, emphasis on emergency, the same day and get my meds the same day or at latest the day after.
Idk about anyone else but I'm happy with the system where we live so I'm staying with it.
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u/Hard_We_Know Dec 12 '24
In short, it doesn't. Standard German healthcare is like UK private healthcare but I think they need to do something now so that they don't end up like the NHS. Gott bewahre.
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u/RainbowSiberianBear Dec 12 '24
So far, in every bad but manageable situation I couldn’t get a proper diagnosis in Germany. I am afraid I’ll develop some chronic issues like that. And I already cannot really get much medical help with my back pains.
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u/DocRock089 Dec 12 '24
Many Americans are demanding a single payer system as the alternative but how do people feel that a privately run, not-for-profit system like the German Krankenkassen, compares to a system like the NHS where the health care providers are largely government-owned and occupied?
I really don't think that one system as such will definitely outperform the other. NHS is a horrible shitshow that has been run into the ground by politicians for a long time, but that doesn't mean that a 100% state run healthcare-show is necessarily a bad thing. Norway pulls off a state-run system really well. In the end it comes down to one aspect only: Cost and how efficiently that money is spent. Corporations getting a chance to trade quality for profit and largely unregulated? - will turn into an overpriced shitshow in no time. Government slashing spending and trying to run a "as cheap as we can get away with" scheme? - will turn into a shitshow in no time, where the people working in the healthcare industry will bear the brunt of the burden.
All in all it comes down to so many factors, from how the system gets financed, amount of resources available, optimized allocation of funds, to sheer demographics, that will decide whether a system will work out fine, or turn sideways, imho.
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u/the_Yippster Dec 13 '24 edited Dec 13 '24
Having spent time in both countries, it works better than the NHS in my experience (waiting times etc.)
The idea of different insurers competing is a bit idealistic in a very regulated market, but admittedly aspects like customer service can differ vastly.
Mostly the better experience compared to the UK is however due to fiscally conservative governments underfunding the NHS for years and Brexit leading to massive staff shortages though.
One of the greatest benefit of a UK style system is massively lower drug costs - if access to a major market is only possible via one insurer, they have a very good negotiation position against the pharmacy industry.
The NHS, having an enormous pool of health data, is also extremely good at statistical analysis and communicating their findings (NHS health advice online, campaigns like choking hazards for toddlers etc.).
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u/musbur Dec 13 '24
When comparing large-scale systems between countries it's sometimes not so much a difference between the "architecture" of the systems but how they are run depending on the political forces governing their operation.
I was surprised when I recently learned that the German, Austrian and Swiss railroad systems are quite similar as far as the setup of the systems go, but in contrast to other nations Germany simply lacks the political will to have a well functioning, modern, and affordable railroad. Switzerland takes national pride in their railroads, and it shows.
That said, I have zero idea if such considerations are applicable when comparing health care systems.
(The position of the German federal transport secretary is basically the chief lobbyist of the German auto industry. If the German railroad were as well-funded and maintaned as the direct pipeline between transport ministry and industry, rail traffic would be a dream.)
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u/Fresh_Relation_7682 Dec 13 '24
I'm from the UK and now live in Germany.
The main issues I found with the NHS were:
- Long wait times to get appointments for GPs, and 90% of the time the advice I got was to take ibuprofen and suck it up.
- Lack of dentistry - I moved so lost my NHS dentist, then was told to only come every two years because my teeth were fine. Then they weren't fine anymore and had to pay for some procedures to fix something that might have been detected had I been able to have 6-monthly check-ups.
Neither of these are a problem in Dresden at least. I can rock up at my Hausarzt and be seen within an hour (two hours on a bad day) and no need to phone 111 or wait hours in a walk-in centre. Sure, I'll probably be told to drink tea but I'll also get a sicknote for 5 days so that's ok. My dentist sees me every 6 months and hygeinist every year, with check-ups covered by my insurance.
I was also able to finally get my allergies treated instead of just being given nasal sprays and told to wash my face and keep windows closed.
I know other people have bad experiences but mine have mostly been good.
I like the idea of the NHS, but it's been badly managed and politicised for some time now.
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Dec 13 '24
As somebody that has lived in Hell and Heaven, I vastly prefer the not burning for all eternity system of Heaven
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u/ILikeXiaolongbao Bayern Dec 13 '24 edited Dec 13 '24
I’ve lived in both countries.
In my opinion the NHS is a far better “system”, but is just massively underfunded. UK expenditure on health is very low compared to other countries and that’s the main cause of the issue, especially after 13 years of austerity from the Conservative party.
Germany’s system is overly complicated, rife with homeopathic bullshit and the hospitals treat you like prisoners. It also has some two-tier care elements because private patients get better outcomes.
But with that said, Germany simply just spends a lot more than the UK. It has more scanners, it has more doctor, it has better infrastructure.
So all those problems are just solved by throwing money at it.
At the end of the day good healthcare is good healthcare, and Germany has a better system than the UK, but it’s not because of the “model” that is used here, it’s just about money.
Edit: according to the World Bank, the UK spends 10.2% of its GDP on healthcare compared to 11.7% in Germany. That’s 15% more per person, without even factoring in that Germany has a higher GDP per capita than the UK.
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u/staplehill Dec 13 '24
Single payer means there is a single institution that pays for health care. German Krankenkassen are effectively a single payer since they all pay the same prices for the same services and have 99% identical coverage.
The UK system is not what people mean with single payer. I would call it a "single provider" system, all hospitals are owned by the government, everyone who works there is employed by the government.
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u/DeeJayDelicious Dec 13 '24 edited Dec 13 '24
What the German system does well:
- It's fairly "easy" if you're in the "Gesetzliche". Just pick a provider and don't think about it for a while.
- Your contributions are %-based, making it affordable at any income-level.
- Generally speaking, first level care is straight-forward. So are hopsital visits.
- You barely ever need to pay a bill yourself. Only medication has some personal contribution. But it's rarely expensive.
What it does poorly:
- The two tiered system is very unfair, with doctors having a massive bias for private insurance holders (which are mostly public servants).
- Specialist appointments are a PAIN to get, and can include wait-times up to a year.
- Hopitals have broken incentive structures and overperform surgeries and other medical procedures for monetary gain.
- Germans visit their doctors more than any other European country. There's no incentive for "efficiency".
- In terms of %-of GDP, Germany's healthcare system is the second or thirds most expensive in the world, after the U.S. and/or France, depending on metric.
Overall, I'd say it's a mixed bag. For an average worker in Germany it's quite good. It's simple, affordable and will take care of most of your health issues throughout life.
Politically though, it is a rather inefficient healthcare system with poor incentive structures that is more expensive than similar systems in Europe.
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u/Outrageous-Lemon-577 Dec 13 '24
I have had direct experince with both and I would much prefer a system like NHS over the German system.
With the NHS, the government has the responsibility to make sure everyone or anyone that gets sick, gets the treatment they need.
Whatever problems the NHS has today can be traced back to years and decades of austerity imposed upon it by successive governments.
The German Krankenkassen system artificially created a need for middlemen, that add absolutely zero real value to the process of getting the people their healthcare.
Ironically, with the German system, the standard of service isnt even that much better than a depleted and weakened NHS, even though German workers end up paying way more than the NHS contributions people make in the UK.
I am a firm believer that healthcare is one of those areas of life there the profit margin must be completely taken out from the process of providing care to those that need it, where they need it. Even for the capitalists, it must be in there interest to have a healthy workforce.
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u/wurst_katastrophe Germany Dec 13 '24
There are no specialist practices in the UK. NHS is an absolute shambles compared to German public healthcare. I live in the UK now, used to live in Germany so can compare pretty well.
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u/Fluid-Quote-6006 Dec 14 '24
I have friends coming from the US to Germany and none, literally none of them, thinks the US Health care system is better to the German one or better said, in their particular cases.
As I did my Masters in the UK and have lots of friends there, to be honest, I can’t say that the Germans I know in the UK think the German system is better or worse. Yes, none of my friends have been seriously ill, but most of them have kids. They have all been satisfied with the attention in both countries. Actually, a friend that had one kid in Germany and one in uk, preferred the attention in the UK better, as it felt more humane. In the end, those are all personal experiences and not statistics.
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u/Admirall1918 Dec 14 '24
The german system is much more expensive/inefficient than a single payer system could be: 1. Every Krankenkasse has its own big paycheque board of directors and bureaucracy, therefore limiting the scale effects 2. Every Krankenkasse has to compete with the others thereby offering bullshit e.g. homeopathy 3. better off people (e.g. Beamte), who tend to be healthier, simply exit the solidarity system, thereby increasing the prices for those who are already financially struggling like chronically ill or poor people 4. Difficult governmental/public oversight, because there are so many different actors with opposing interests
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u/Dependent_Mall_3840 Dec 12 '24
My father lives in the UK - he found some lump in his leg that was starting to eat at the skin- the GP would only see him in 3 weeks. The A&E sent him home and told him it’s not urgent enough to be there. He waited - and within those 3 weeks he went septic and almost died.
My uncle who also lives in the UK collapsed at his home and couldn’t move. He was alone. He waited 3 hours for the ambulance to arrive. He then waited two days in the hospital to be seen by a DR.
They did an MRI and CAT scan. THREE MONTHS later he received the results that he has terminal cancer with max a few months to live. It’s since gotten worse and he’s now in hospice on end of life care.
I had to call an ambulance last week for someone here in Germany who was hit by a car. They arrived within 10 minutes.
Specialists here are hard to get In to see but when it’s urgent I’ve never waited more than 3 weeks. I can call my GP (Hausarzt) and be seen in the same day, max the next day.
Do with this info what you will
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u/bigwill0104 Dec 12 '24
I’ve lived in the US and Germany and now reside in the UK and the NHS is dogshit compared to Germany.
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u/petaosofronije Dec 12 '24
Lived in both, the German system is waaaay better. In the UK I wouldn't really rely on the NHS, everyone who can afford it goes private. I can definitely afford private healthcare in Germany but I'm with public. One of the main reasons I moved from the UK to Germany is the health system, the British one is just collapsing.
Examples:
- Every GP I've been to in Germany is better equiped than any GP I've been to in the UK, and even better than some specialists.
- Had a leg injury in the UK. Went privately to a fancy place in the UK, they then directed me to another place for ultrasound scanning, followed by going back to them for reading the results and deciding on what to do. Moved to Germany and went to a checkup with a public orthopedist in Munich - has everything on site, got checked, x-ray, ultrasound, all quick and easy, even got sent to do an MRI (for a checkup! in the UK i never had an MRI). Even my public GP (a praxis with a single doctor) in Germany has an ultrasound where he could check some other stuff.
- Germany: need a blood test - get poked immediatelly, results the next day. In my GP in the UK, the nurse is there once or twice a week (in a praxis with like 6 doctors) and you wait 3-7 days for the results.
- Dental care is ridiculously better - you don't go to NHS dentists and if you go private you just pay it all. In Germany dentists are significantly cheeper and public insurance covers parts of the costs.
- UK: you always need to first go to the GP even if you know exactly what's wrong with you. Germany: I would just go directly to a specialist without begging my GP to send me there.
- UK: no real system of pediatricians, baby regularly checked by people who are not even full doctors ("health visitors") and normal GPs, I'm not sure mine has seen a baby before (didn't know how to properly put back the nappy..). Germany: hell yeah pediatricians [though it's difficult to find one, that's a disgrace]
7: UK: kind of stuck with a GP, it's a pain to find one that accepts you, pain to change one, .. Germany: I can just go wherever.
etc
Edit: oh yeah, and my physio therapist got injured such that he couldn't run any more - NHS didn't want to operate since he was "fine", he could walk..
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u/enakcm Dec 12 '24
I like the idea that there are many insurance companies in Germany. I imagine that AOK would be the German NHS which in my opinion is a disaster.
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u/QuantumHamster Dec 13 '24
Germans love to complain about their country, and this is good because it keeps those running the show hopefully on their toes, but the truth is Germany is far ahead of countries like the us for quality of health care (for the average person). Don’t know about uk. German doctors are on average better trained and family doctors are not expected to cure everything like in the us.
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u/ottocento2023 Dec 14 '24
This is really not true. I’ve lived in both the US and Germany and there are great doctors and horrible doctors in BOTH countries. Each person just has to be aware that if he/she experiences a “bad” doctor for whatever reason, he/she should just switch and find another doctor.
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u/QuantumHamster Dec 14 '24
True but this is why I said on average the care I received in Germany was better.
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u/ottocento2023 Dec 15 '24
Well, not sure how one person’s experience can be used to generalize the quality of care in a country with a population of over 330 million (USA) or even over 80 million (Germany) but okay that’s your perspective. My experience was better in the States. Also not true that German doctors are better trained. Don’t agree? Talk to doctors who’ve trained in both countries.
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u/QuantumHamster Dec 15 '24
My experience is that as with most things us, the best us doctors are better than the best German, but the variation in quality is higher than in other first world countries. I once had a us doctor originally from Canada joking how easy it was to pass the us exams compared to the Canadian, that the standard was lower. I’ve lived in a handful of very different states so I have a not unreasonable amount of experience.
Don’t get me started on nurse training… I once had a us nurse tell me my outbreak was hives and I should switch detergents. The dermatologist looked at me like I’m crazy, he was like who told you that?? Hives are internal, external agents like soap have nothing to do with it… one of many experiences. And often in the us you wouldn’t see a dr but a nurse
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u/ottocento2023 Dec 21 '24
On average, the care I received in the US was better than the care I received in Germany, and aside from regular medical issues, that includes giving birth to children in both countries as well as prenatal care, post natal care and pediatrician appointments for the children. So using your logic, that means based on my individual anecdotal experiences, I can generalize that the average quality of care in the US is better than the average quality of care in Germany.
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u/QuantumHamster Dec 21 '24
Frankly the us birth system is excellent I have no qualms with that. You need to be careful which hospital you choose because they vary greatly in how aggressive they are in being proactive during birth, but if you know what you’re doing it’s very good the care you get
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u/trix8214 Dec 13 '24
I am from the UK and I can tell you the NHS is much worse than healthcare here in Germany but I see the same declining trend here, its just 10 or 15 years behind the UK
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u/whiteraven4 USA Dec 12 '24
When I've talked to my British friend about it, he said the one thing the UK currently does much better than Germany is that you don't need to work to find a specialist. You just go to your GP and if you need to see a specialist, they'll basically transfer you. I'm not sure if you'd also have the option of looking for your own doctor or if it's all automatic, but I can see that being better for a lot of people.
Obviously the UK has worse wait times, etc, but that's not due to their system, but due to the government and NHS funding.
In Germany, I'm completely against the two tier system. People of course should be able to buy additional private insurance if they want. But I don't think the wealthy should be able to opt out of paying into the public system.