Insurance and Medical Matters in German-Speaking Europe

All of the German-speaking countries enjoy a high level of health care. Infant mortality rates are much lower (US: 5.87 per 1000, DE: 3.43, A: 3.45) and life expectancy is higher than in the United States. (Switzerland is second in the world, after number one Japan. See the comparison chart below.) The German health care system, with its mix of public and private health insurance, was taken as a model by both the Clinton and Obama administrations in their efforts to reform the US system. While not without its problems, the Austrian and German government-sponsored Krankenkasse (“sickness fund”) system provides universal health coverage in Austria and Germany. Switzerland relies on private insurance.

Living in Germany > Health Care in Germany

An Apotheke in Berlin-Spandau. It’s more than just the German version of a pharmacy. The German Apotheker can help you with your ills more than an American pharmacist. On the other hand, you can’t just go into a German drugstore and buy aspirin. PHOTO: Hyde Flippo

German Health Insurance Requirements
Thanks to Otto von Bismarck, Germany has the world’s oldest national health insurance system, dating back to the late 1880s. Originally, the state health insurance laws applied only to low-income workers and some government employees, but now about 90 percent of the population is covered by national health insurance (Gesetzliche Krankenversicherung, GKV). The rest, including many expatriates living in Germany, must have private insurance. In order to obtain a residence visa, foreign residents must prove that they have some form of health insurance coverage, either private or through their employer. All salaried employees must have public health insurance.

German health care insurance is paid for by the employer, employee, and taxes. In Germany, the average employee salary contribution is 15.5 percent. An employee’s public insurance also covers family members. The unemployed, retirees, or those on welfare get government-paid coverage. Because of minimum income requirements, about half of the working population, mostly blue-collar workers, have no choice of which health plan they will join. The more affluent can opt out of the system, and private coverage is available for people who can afford to avoid the basic care of public facilities. A non-German resident will not be covered by the Krankenkasse unless qualifying through a German employer. Upon entering a hospital for treatment, a patient presents a Versicherungskarte or insurance card. Payments to doctors, the hospital, or a health spa for in-patient or out-patient care go directly to the health care provider; the patient pays a modest share of only about 10 euros per day for a hospital visit.

No Over-the-Counter Drugs
A Drogerie, despite its name, doesn’t sell drugs or medicines. A German “drug store” is more of a mini-mart for beauty products, toiletries, and detergents, but not medicines. The Apotheke is the German equivalent of a pharmacy. But you can’t simply pick out a box of aspirin and pay for it. All the Arzneimittel or medications, prescription or not, are located behind the counter or in the back room.

The official German pharmacy logo.

Designated Apotheken stay open all night. To find out which one is open, any nearby Apotheke has a sign in the door indicating the one that is open that night. This information is also published in most German daily newspapers [and on the Web]. The Apotheker can also help you avoid a trip to the doctor (Arzt) by giving you pharmacological advice. If you ask the pharmacist about a medical problem, he or she will usually be able to provide an appropriate ointment, pill, or salve. If you don’t speak German, many pharmacists speak English. If you have a written prescription (Rezept) from a doctor, there is very little difficulty. For more about this topic, see Medications and Prescriptions in Germany.

Taking the Cure: Das Bad = bath or spa
People in the German-speaking world are very health conscious. They are interested in prevention (Vorbeugung) as well as cure. Health foods, vitamins, natural foods, biologically-grown foods (Biokost), and herbal teas can be purchased at a Reformhaus or Bioladen. A Kurort is a resort for preventative medicine, recovery, or cure. It can be a spa (Kurbad) or a resort famed for its fresh air and climate (Luftkurort). Europeans, especially the German-speaking ones, hold “taking the waters” in high regard. A few days at a Bad (baht) or spa can do wonders for anyone’s health, even if it’s just to relax you. But various spas or Bäder (BAY-der) are known for waters that cure a specific health problem; certain spas have water with particular minerals that are claimed to be best for certain ailments. Taking the waters (eine Kur machen) can involve drinking them, swimming in them, or both. Going to a spa or Bad is also covered by Austrian and German health insurance plans. A doctor may prescribe eine Kur.

Baden-Baden, Bad Homburg, Baden-Württemberg, Wiesbaden, Bad Dürkheim, and all the other German place names with some form of Bad, derive their meaning from the Roman baths or spas that were once located there. Many, such as Baden-Baden, still attract visitors to their baths today. The word Bad in front of a German town’s name is an official designation as a Heil- und Kurbad, a health and curative spa.

Cigarette Smoking
One area in which German-speaking Europe seems to be less health conscious than most of North America is smoking. For Germans over the age of 17, the smoking rate is a shocking 37.4 percent for males and 25.8 percent for females (WHO, 2008). Among German 18- to 25-year-olds, the rate was 36.8 percent in 2011, down from 44.5 percent in 2001. Despite health warnings on cigarette packages and anti-smoking ads similar to those in the US, Austrians, Germans, and Swiss continue to light up more than Americans (24% of men, 18% of women). Austrians have an even higher smoking rate than Germans: 46.4 percent for males and 40.1 percent for females. In the last few years, Germany has begun to pass laws restricting smoking in restaurants and bars (even at Oktoberfest!), and in public buildings. Similar anti-smoking laws in Austria are often ignored. See Smoking and Vaping in Germany for more.

German and Austrian Medical Pioneers
German-speaking scientists and physicians have long been leaders in pioneering medical breakthroughs. The vital medical tool of x-rays was discovered by Wilhelm Conrad Röntgen (1845-1923) and the German word for x-ray is Röntgen. The Austrian physician Leopold von Auenbrugg (1722-1809) developed the diagnostic procedure of tapping a patient’s chest or back (percussion) to determine the amount of fluid in the chest, a technique used to this day. Robert Koch (1843-1910) won a Nobel Prize in 1905 for his work on tuberculosis. He also made important discoveries related to anthrax, diphtheria, cholera, and other diseases. Austrian-American Karl Landsteiner (1868-1943) discovered the four primary blood types in 1901. He went to the US in 1922 and received the Nobel Prize for medicine for his work in immunology und virus diseases. Aspirin was invented by a chemist with the German Bayer chemical firm in 1893. One of the most famous doctors of all time was born in German Alsace, now in France. Albert Schweitzer (1875-1965) spent most of his life in French Equatorial Africa caring for the native inhabitants. He received the Nobel Peace Prize in 1952.

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Related Pages
AT THE GERMAN WAY

• The Apotheke Way – Alie writes about her personal expat experiences with her local German pharmacy.
• Medications and Prescriptions in Germany
• GW Expat Blog: The German health care jungle – The ins and outs of the German health insurance system
• GW Expat Blog: Rx for Drugs in Germany – Lessons from the field
• Having a Baby in Germany: Prenatal Care (Part 1) and Having a Baby in Germany: Giving Birth (Part 2) – Advice from two expat moms in Germany
• Popular Expat Blog Posts – The top expat blog topics
• Living in Germany – More expat topics

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