Necessary and Enough: How Two Main Principles of German Medicine Work

Anna Berseneva, Germany

A good doctor can be found, if not quite everywhere, then still in many countries. Dating, money, luck - these are the three components of a successful search. In Germany, it is also not harmful to have friends who will say: "I was treated by Professor N, here I am standing in front of you alive and well, go to him too." And money will also come in handy, since not all professorial consultations are free. But there is an essential clarification: you will be treated "to the fullest" in Germany, regardless of whether you have money or not. There will be nuances in conducting research - but all the necessary research will be done. The ward will be for several people or a separate one - but in any one the buttons at the head of the ergonomic bed and the toilet cistern will work in the same way. The nurses will be attentive to you, not expecting any money from you, or even the notorious chocolate bar. For a surgeon or anesthesiologist to announce before the operation how much you should bring him in an envelope ... This is even impossible to imagine in Germany.

The explanation for all this is simple: this is how the German insurance medicine works. That is, it is arranged in a complex way, like all mechanisms that work effectively in various situations. But the result that the patient feels is simple and clear: if you live in the country (legally, of course), then you are insured in a public or private insurance company. And that means that you will be provided with all the help that is necessary to preserve your life and health.

I'll make a reservation: I would not like to explain here how the wheels and cogs of the German health insurance system interact with each other. This is really a very complex mechanism, it has many subtleties, which is hardly necessary for everyone to understand. It is more important for an ordinary person, at least, to understand who to go to when “you feel bad about something”.

And one should go to the "family doctor"; perhaps it would be more accustomed to someone to call him a district therapist, because his functions are just that. You can make an appointment with him online or by phone, or in person. It is convenient to do this on the way to work, since the word “home” usually has a direct meaning: the one who is closer to home.

That is, of course, no one forces you to choose the closest doctor as your home doctor, but why not? If a doctor is engaged in medical practice, then his qualifications have been tested in Germany so thoroughly and at so many stages that I, for example, would not consider myself able to understand it better than it has already been done by the entire German healthcare system. However, personal disposition to the doctor is also an important matter, and every patient has the right to strangeness, so if someone finds a suitable therapist for themselves only at the opposite end of the city (or maybe even in another city), then good health. You make an appointment for a certain day (you will be reminded of it more than once by e-mail), do not forget your insurance card at home - it looks like a bank card and is read by the terminal at the reception - and you go to the appointment.

My friend, in her declining years moved to live in Germany, did not philosophize and took out medical insurance in one of the state companies, as her peers advised her. After a year of living in the country, she concluded that in her case, with the usual age-related ailments such as high blood pressure and sugar, public insurance differs from the more expensive private insurance only in that it takes longer to wait for the appointment of the appointment date. All other studies that she really needs are assigned for any insurance in the same way.

The key word, she said, is "really." Because in Germany, as elsewhere, there are many people who love to undergo treatment for their own pleasure, and it is the family doctor who determines how much they need it. But! It is important that he does this not according to the principle “a woman, what do you want, in your years everyone hurts”, but on the basis of the patient's complaints and the results of the primary research conducted on his complaints. According to these results and in accordance with verified protocols, medications or procedures are prescribed, and referral for consultations to specialists. A friend says that she has never been refused in this direction. True, for her own pleasure, she is not eager to go to doctors, so her intentions coincided with the medical necessity revealed by the therapist.

I am very interested in what they do with hypochondriacs! Are they referred to all the professionals they wish to visit? I suspect not, because a referral from a family doctor just means that the insurance company will pay for an appointment with these same specialists. And the German doctor will not initiate payment for empty suspiciousness.

In the same way, I was interested in what would happen if I went to see a specialist on my own initiative. A friend immediately explained: they will most likely accept without a referral from a family doctor, and for a visit to some doctors - a gynecologist, a urologist - it is not necessary at all. But it's better to take it all the same. Why? Because without such a direction, additional research, which you might want to be done during the appointment - an ultrasound scan, for example - will have to be paid for on your own. And if in a direction from a family doctor it is written that you have complaints that require an ultrasound scan, then it will be done for you under insurance, that is, for you free of charge. In general, the patient's complaints inspire confidence in the doctor, but there are many ways to check how well-founded they are.

By the way, on the first visit of my friend to the family doctor, she immediately screening - blood and urine tests, abdominal ultrasound. And according to their results, they began to understand further. An additionally prescribed blood test showed that it is inappropriate to reduce sugar levels with drugs - only diet. But the cuff, with the help of which the pressure was measured in dynamics during the day, helped to understand that medicines to reduce it are still needed on an ongoing basis. All this was done so consistently and convincingly that my friend was wary when the doctor said during the ultrasound: “But this and this does not bother you? Well, you don't need to do anything with this, and you don't need to do anything about this”, - she immediately calmed down, realizing that she was in a safe area outlined by the words “necessary and sufficient”.

But what amazed her even more than the length of her visit to the family doctor, which allowed her not only to undergo a check-up, but also to speak in detail about all her health concerns, was the free medication. That is, they are, of course, paid, since nothing free exists in society. But the insurance company pays for them. Any. Medicines. Discharged. A doctor. It doesn't matter if it is a cheap ointment for redness on the elbow or an expensive drug for a rare disease - both will be free for the patient. Because drugs are necessary for treatment, and insurance medicine exists for this, so that treatment is available to everyone.

Perhaps the most surprising thing about all this is that after a week in the field of the German health system, this approach seems to be self-evident. And high German taxes cease to cause outrage when you understand what public health insurance is and how it works.

This is especially well understood by people who suffer from serious illnesses that require expensive and, most importantly, lifelong treatment. I have seen one such story in Germany personally for several years. I will definitely tell you about it!

Dissenting opinion of a resident of Berlin Yelena Ivanova:

Somewhat without doubting the sincerity of the author and the correctness of her notes about the delights of the German health care system, I want to share some personal moments and less rosy ideas about how and who is well treated in this country.

There is a very big difference between compulsory and private insurance, and first of all, in its cost. Private insurance is not only a privilege, albeit minimal, in medical care. First of all, this is a big financial burden. Firstly, all residents who have an income of more than 64 thousand euros per year, or 3 thousand euros after taxes, are required to pay private insurance. It is said that its cost is calculated based on age and health status. As a person who considers himself healthy and runs 10 kilometers every morning, I pay 800 euros a month, while the bills for the first three thousand euros I have to pay myself. After 55 years, it is almost impossible to get out of private insurance and go to public insurance. That is why there are many pensioners who pay a thousand or more just for the right to receive medical treatment. Only recently did insurance companies introduce direct payments to clinics and doctors; before that, patients first paid everything themselves, and only then received compensation from the insurance. If you do a dental treatment, there are thousands that must be found first in order to return later. Imagine that your income is 3 thousand per month. From 500 to 1000 euros you pay for the apartment. 900 euros will go straight away for insurance, and there is not so much left, especially if you have children, a car and other attributes of a happy life.

Compulsory insurance is also a thing in itself. It is built on the principle of solidarity. If you worked for 40 years and paid 30% of your salary for social services, then your life looks like the respected author describes. But everything changes if you are a mother of three children who raised them at home, or a migrant who came to the country 10 or even 20 years ago. Insurance payment is calculated not based on the income of each, but on the total family income. My husband is a pensioner, he receives 600 euros of pension, and his insurance is 870 euros, because its cost is calculated not only from his, but from our total income. Either those who have paid social tax all their lives or recipients of social assistance who have nothing to take pay little.

The level of medical care in Germany is very high, but, as elsewhere, there are good and bad doctors. It's good if you are lucky and you will immediately find top-class specialists in all specialties. In real life, everything is different: after moving to Berlin from Munich, I had to change 4 (Four !!!) dentists to find a really good one. Believe me, we are not so picky. My husband went from doctor to doctor for 3 months with a toothache, until he found a doctor who healed his canals. And this is not an isolated example, just go to Facebook and see what citizens write about their experience.

You can really get a referral from a therapist to any doctor. But this does not mean that you will be recorded immediately. Yesterday, February 22, my friend received a coupon for May 5 (fifth !!!) to a gynecologist, and this despite the fact that she underwent surgery for cancer. Now, getting to doctors, including good ones, has become easier, because during a pandemic, people do not go to get treatment so often. Before the pandemic, I tried to make an appointment with an ophthalmologist. And although I have private insurance, I was unable to do so - not a single ophthalmologist in the area accepted me. I had to look through my friends.

So with all the obvious advantages, getting treatment in Germany requires patience, time and money. If you are lucky enough to have all three of these conditions, you will receive the best medical care in the world!