German health system versus the NHS: a comparison

My stepfather’s treatments 

In the late 1970’s I went to work in Germany in a hospital for children and adolescents. My mother and English stepfather came to visit me frequently from the UK. My mother had continued paying into her German health insurance membership when she married my stepfather and moved to the UK.

She had had several major operations before her move and always had a check-up in the small town called Marl, where I worked. My stepfather was also covered by her insurance and it was during one of those visits that he was diagnosed with cancer.

His family had paper mills with asbestos walls and he had spent his childhood playing – and then his young adulthood working – in the family mills. He developed emphysema, and then mesothelioma.  At that time not much was on offer as effective treatment for that type of lung cancer. Alternative therapists suggested double doses of vitamins and the prognosis was not good. 

When my parents returned to the UK, the opinion given to my stepfather by his British GP was that the survival for his type of cancer was about six months. He was 68 at the time. 

Heidelberg lung cancer clinic

My mother researched what was offered to cancer sufferers in other countries. She found that a specialist clinic in Heidelberg was trialling several new drugs. There was also a report about an alternative therapy available in Hungary. It was easy to make an appointments at the Lung Cancer clinic in Heidelberg, who took my step father as a patient. He received two experimental medicines which sounded very promising.

In order to get an appointment at the specialist clinic in Germany at the time, one could call the clinic directly and request one. The health insurance company, overseen by a government commission, has a list of treatments they cover. Consultants know these and they receive payment from the insurance company for treatments they undertake. 

Dialysis in Germany

When  my stepfather’s kidneys gave up, sadly, due to scarcity of machines and specialist staff in the UK, there was no offer of dialysis. Since he could not receive this life saving treatment from the NHS, he moved to Marl. He spent three days a week in the local hospital in a nice single room. Of course, my mother and the occasional visit of one of his children kept him company.

My stepfather lived for another seven years but he spent the last years of his life commuting between Sevenoaks and Germany. It was where he finally succumbed to his illness. He had lived a lot longer than the prognosis had predicted. That was partly due to the excellent traditional and alternative treatments he received from three different health services. Here, the experience of my mother came in handy. She had doctor contacts in Austria, Germany and Hungary and she pulled all the triggers.  

How the German health system works

From 2004, the German health system has been 77% government-funded and 23% privately funded by statutory health insurance and private health insurance. Now workers and employees who make less than €5 362.50 per month, ie about 89% of the population, are obliged to pay into one of currently around 105 public, non-profit ‘sickness funds’ (Krankenkassen).

The list of ‘Krankenkassen’ enables one to compare and calculate contributions according to personal income. It works out at approximately 7.3% of monthly income paid by the employee, after the employer has paid the same percentage. For example, for an income of €3 000, there is a deduction of €238.5 for health insurance.

People on social benefits are also enrolled in statutory health insurance, and social services pay contributions on their behalf.  The sickness funds cannot refuse membership or otherwise discriminate on an actuarial basis. 

Arrangements for the self-employed

The self-employed or those with independent income can opt for an alternative private health insurance which might cover treatments not included in the statutory insurance. There are some differences in contributions for extra services and what can be added as a service, e.g. preventive treatments. Dental treatment is covered, with some specialist treatments partly funded, if the dentist makes a case for it. 

After surgery, physio and even spa ‘cures’ are offered when considered beneficial. It is found to be cost effective to prevent future treatments by keeping patients healthier.

Who pays the providers, and how much?

Payments to providers such as doctors, hospitals, pharmaceutical companies etc are negotiated in complex social bargaining among self-governed bodies (eg physicians’ associations). Since it is a national health service supplied by various regional and theme based ‘Krankenkassen’ (eg for various industries and professions) the services they provide have to reach a certain standard.

The negotiations for price of suppliers is competitive but they are held by associations for their members and not individual providers. For the patients, there are strong consumer protection organisations pressing for value for money. 

NHS: free at the point of use

Here in the UK, there is no financial procedure for the patients at the point of NHS treatment. Unless you are not registered with a GP, and are suspected of being ‘benefit tourists’ from abroad. So most patients know nothing of the cost of their treatment. In Germany the insurance provider used to issue a cheque book style health book, which the patient would hand over to the physician. The book automatically contained standard checkups.

Now people receive a credit card connected to an online system. The health provider claims fees for whatever treatment the patient needs. Many surgeries do simple procedures, take blood tests, ultrasound tests. Some even have their own  laboratories, depending on the size of the surgery. 

In Germany there is greater freedom of choice

The fact that people can turn directly to consultants and clinics is widely advertised and the information is regularly sent out to the insured. Through frequent invitations for checkups, people are kept informed about their state of health. Obviously, GPs can refer you to specialists as needed.

Friends living in Germany report that the services which insurances cover have been cut back due to rising costs and a growing population. Still, at the patient’s end, the system grants more freedom and easier access to doctors and treatments than we have here in the UK, albeit at a cost.

There are much shorter waiting times, as there are around four doctors per 1,000 people. 

Number of doctors per 1,000 population 

According to the figures by the WHO, the UK has 2.8 doctors for every 1 000 people. The average across the 33 countries is 3.0. Austria has 5.1 doctors for every 1,000 people. Germany, Italy, Lithuania, Norway, and Switzerland all have more than four doctors for every 1,000 people.

Who does the NHS belong To?

We are all very grateful to the wonderful NHS. It has saved my life in an emergency, and I have had my two vaccinations in an amazing surgery. But it is under threat after years of under-funding, a new law that makes privatisation more likely, by the extra pressure through the pandemic, and by the exodus of many fellow Europeans who helped keep it afloat. 

The NHS must not be sold off for profit. It must remain free for patients in need. How can we protect it and how can it survive a growing, ageing population, government underfunding, rising costs and Covid? It might be a controversial question: can we afford to carry on offering free treatment? Letters to the editor are invited. 

Healthcare in Germany

Healthcare in France