This past weekend I took a trip to the ER in Berlin. I had some pains with an old injury I sustained when I was 15 and I needed to make sure it wasn’t going to develop into something worse. As it happens, it did end up developing into something, but not in the way that could have been life-threatening. Consequently, I got the chance to see a little more of how the medical system works in Germany.
Back when I was living in the US, healthcare was a hot issue. A few years before I left, health insurance was the focus of a lot of the headlines and political discussions. At issue was the fact that millions of people were uninsured and could not afford to see a doctor. Furthermore, medical payments were the leading cause of bankruptcy in America. If you got sick and couldn’t afford the treatment, you were fucked. Either you suffered and died, or went into financial ruin to live. I’m not really sure how much has changed since then. I remember at my last job, we had 3 “sick days” per year, meaning we could call into work “sick” 3 times every 365 days and still get paid, otherwise we would need to use up our 5 days paid vacation time if we wished to stay home and still get a paycheck. If you couldn’t afford that, tough shit; swallow a bunch of painkillers, bring some tissues, and go to work.
At the time, people were arguing over whether the solution was a health insurance system run by a few private corporations, a tax payer funded public system, or a hybrid of the two. I remember watching the corporate news which was full of all sorts of incendiary reports on how terrible public healthcare was. The message being sent to the American people was that public health insurance, like in evil socialist Europe, was a disaster. News stories would report that in Europe it takes forever to see a doctor, that you can die waiting for your surgery, that the government would choose what doctors you could see, that there are no good doctors because the good doctors have no incentive to work in a publicly funded system, and that if the US adopted a public health insurance system, a government death panel would kill your grandmother.
In the end, there was too much money at stake for the decision to be left up to the American populace. The health insurance companies wrote their own bill and had their puppet politicians push it through congress as “Obamacare.” It lacked a true public option and served only to further reduce competition and essentially forced millions more people to buy insurance from the very same companies that wrote the bill.
Here in Germany, there are two types of health insurance, public and private. Unless you make over 55,000 euros a year you are required to be covered by at least public insurance. This is not to say the public insurance is bad, far from it. Private insurance is more expensive, but there are some doctors in Germany that only take private insurance. Additionally, there are some cosmetic procedures that are not covered by public insurance. I have public health insurance which comes out to around 400 euros a month in taxes. My employer pays the other half. I’m quite glad I have it, as I’ve used it a few times now.
I did a search online for general doctors, called “Hausartz” or “home doctor”, and found one near my office that speaks English. Nobody told me I have to go to her practice specifically, and I’m free to change to another doctor whenever I feel like it. When I visit, I wait roughly the same amount of time I did in the US. Sometimes an hour extra if I have an appointment, sometimes 2 hours if I don’t have an appointment. When I’m done seeing the doctor, I can walk straight out the door; no charge. I usually spend between 10 and 20 minutes with my doctor, depending on what the visit is about. It’s not rushed, and I don’t feel stressed and like she is only allotted 5 minutes with me. I’ve had blood work and other tests done, also with no charge.
While my Hausartz speaks English, the language barrier can be frustrating with other doctors. The level of English proficiency is hit or miss sometimes. A doctor might speak English, but that doesn’t mean the people working the front desk do. It can be a little uncomfortable to try and set up appointments, but you usually end up only using a very limited vocabulary for those conversations, so I manage. I sometimes have Insa come with me to the doctor’s, just to be sure they understand exactly what I mean, and that I understand exactly what they mean. I have a very bad habit of nodding my head in agreement and saying “ja, genau” even when I don’t understand what someone just said, which is not a good thing to do in medical conversations.
When my doctor writes me a prescription, I take it down to the pharmacy, or the “Apotheke.” They usually look like this:
There aren’t really convenience store/pharmacy hybrids like Walgreens, Rite-aid, CVS, etc. in Germany. Pharmacies are their own stand-alone businesses with highly trained technicians working the counter. If you have a minor medical issue, they can suggest medications to take and what to avoid. Pharmacies here have slightly extended business hours, but do eventually close for the night. That doesn’t mean you’re shit out of luck if something happens late at night. All the pharmacies in a neighborhood work together in a sense. They take turns every night offering “emergency service.” During the emergency service hours, the pharmacy might appear closed, but a pharmacist is on duty and will respond to a buzzer. If you go up to a pharmacy and it is not doing emergency service that night, a sign on the door will give you the address of the nearest pharmacy that is doing emergency duty that night.
The only time I’ve had to pay immediately and up front for medical services in Germany has been getting drugs at the apotheke. Depending on what drugs you’re getting, sometimes there is no charge, sometimes there is a partial charge, and sometimes you pay the full price. At my last visit this weekend, I paid the most I’ve ever paid, 15 euros for a big box of painkillers, a box of muscle relaxers, and a special drug to help my stomach. Had my doctor prescribed me a back-brace, I could have gotten that free of charge as well.
My experience in the US was that drugs could easily costs almost a $100 depending on how many and what. If you walked away spending only $30 then you got off easy. As part of diagnosing my current issue, I also have to undergo and MRI scan. I’ve had one done in the US before and it cost around $2,000. Here it won’t cost me a penny. Knowing my hausartz was probably going to send me to a specialist doctor anyways, I just went straight to the specialist and had them examine me for the issue that landed me in the ER a few nights before. They wrote me a note for an MRI scan, and gave me a list of places around Berlin for me to go to. I could choose whatever place I wanted. If one place had an opening quicker, then I could go there. Insa called a few places and explained my situation and how I was in pain, and I’ve got an appointment for the middle of next week, which is a pretty good turnaround time.
I’ve had vastly different experiences between the American and German emergency rooms as well.
In the US, specifically Virginia and South Carolina, it’s been my experience that wait times in the ER are between 4 and 7 hours before you see a doctor. (Depending on the emergency) This past visit to the ER in Berlin was actually my 2nd visit. On both trips my wait time was between 1 and 2 hours. I thought that was great, Insa thought it was terrible. Insa told me that she had to take a girl she was watching over to the ER in Switzerland and the wait took longer than 5 minutes and the hospital apologized to the girl and gave her a teddy bear and a coloring book.
While in the ER, I was put on a bed, had a needle and valve inserted into my arm to allow for easy blood tests and for medicine to be administered if needed, and I waited in a bed in the hallway of a ward with the other patients.
The doctor on duty was in a separate room and they would wheel you into the room to be examined when your time came. I usually waited between 1 and 2 more hours to be seen by the doctor, bringing the total time in the hospital from start to finish around 5 hours. (Side note, there was a homeless guy in the ward that the doctors were trying to extract his name. He was clearly drunk and kept naming Russian politicians as his name, much to the bemusement of everyone else in the ward.) When I left the ER, I walked out without having been asked to pay a thing. There isn’t a cash register in the hospital because you’re not expected to have to pay. On one visit to the ER in the US, I thought I had a heart complication that turned out to be just acid indigestion. That trip and the 4 hour wait cost $700.
In the two times I went to the ER, both times I took a taxi. It’s a 5 minute trip and cost me about 6 euros with tip. If I had a more serious issue and was unable to make it to the hospital under my own power, I could have called an ambulance and my public health insurance would have paid for it. I’ve heard plenty of horror stories in the US where people refused to call an ambulance when they needed one because they couldn’t afford one. That or they were incapacitated and someone else called an ambulance, only for the incapacitated person to be given a bill for several thousand dollars after they reached the hospital.
There is also an emergency traveling doctor service here in Berlin. If you can’t make it to the hospital, and it’s not life-threatening enough to warrant calling an ambulance, there’s a service where you can call a traveling doctor to come visit you where you live. I ended up using this service over the weekend as I could not physically get out of bed without a nauseating amount of pain. About 2 hours after Insa placed the call, a doctor showed up at my apartment and came in to see me. He ended up not really being able to do anything for me other than give me an injection for pain, but it was still interesting to me that this service existed. (Though to be honest, the doctor we happened to get was a complete asshole. I’m not sure what he normally expects during house-calls, but I wasn’t it and he wasn’t too happy to be there.)
The one complaint I do have about the health system here in Germany is the lack of handicap accessible buildings. In my current state, I am unable to walk or stand for prolonged periods. When I was at my worst earlier this weekend, I was unable to lift myself out of bed or roll over. All of the doctor offices I’ve visited have stairs you must climb before reaching the office. My apartment has an elevator, but you must climb an initial 4 steps to get to it. In the US, federal law requires that certain publicly accessible buildings have an easy way for someone in a wheelchair to access them. It’s crazy to me that, as advanced as Germany is in a lot of other areas, there is still no requirement that buildings like doctor’s offices be accessible to people who can’t walk.
Earlier I mentioned how at my previous job in the US, we were “allowed” 3 sick days per year. Germany is also very different in this regard. First off, there isn’t some set “allowed” sick days off per year. When you’re sick, you’re sick. As much as Germans love to plan ahead and schedule things, you can’t plan for sudden illness. In Germany, it’s the law that you can call out of work sick for 3 days in a row without needing a doctor’s note. As it happened for me, I had my ER visit on Saturday night, the emergency house visit on Sunday, and then was stranded on my couch for three days until I was able to move and see a doctor on Wednesday. Had I suddenly felt better on Thursday, I could have gone into work and the 3 days I missed for being sick would not have been an issue. I couldn’t do that in the US. I saw a doctor on Wednesday and she wrote me a note excusing me from work for the rest of the week.
It’s been my experience that doctors in Germany are very quick to write you a note excusing you from work for medical reasons. My doctor even offered to excuse me from work for the next week too, but I said no because I didn’t know how I would feel by then and I felt too guilty about it. The guilt about missing work is still hard to break. I guess it’s just the American cultural upbringing, but I feel bad even though a doctor has said I’m not fit to travel to the office and work. I had a coworker bring my work laptop by my house yesterday so I could at least do a few small things while resting. I’m going to see how I feel on Monday morning to see if I can make it into the office. If I still can’t pull myself out of bed without a large amount of pain, I’m going to visit the doctor again and see about getting more time off to rest, which I’m sure they’ll easily give me in that condition.
I’ve talked to Insa about this a few times on past occasions and she’s remarked that it’s her impression that in the US, there is this attitude of “just take some pills to mask the symptoms so you can get back to work!” I’m inclined to agree. Here, I find there is a very different cultural attitude towards being sick, at least among my non-American friends and coworkers, that focuses more on getting better first and working second. While I’ve had a pretty shitty week physically, I’m glad I’m living in a country with this kind of attitude towards health.