Seven of the biggest healthcare culture shocks in Germany

Scared of falling sick when living in Germany? Don’t be. The country’s healthcare system is among the world’s best – even if things can be a little different to what you’re used to. To lessen the shock, here’s The Local’s guide to the cultural quirks that might trip you up.

Seven of the biggest healthcare culture shocks in Germany
Photo: Jesper Aggergaard on Unsplash

Dealing with the healthcare system in a foreign country can be one of the most daunting things about living abroad. When you’re ill, the last thing you want on your visit to the Hausarzt (GP) or the emergency room is to encounter unfamiliar medical conventions that might come as a shock when you’re feeling more than a little delicate already.

To help you brace yourself, we’ve teamed up with ottonova, a private health insurer offering special rates and English-language support to expats earning over €61,000 a year in Germany, to show you exactly what to expect when using the country’s healthcare system.

1. Getting naked is normal

Germany’s penchant for naked saunas and nudist sunbathing is well known, but it still comes as a shock to many foreigners that this Freikörperkultur (free body culture) also applies to healthcare. Doctors won’t bat an eyelid at asking you to strip off your underpants in front of them as they continue talking to you, or calling in a specialist to greet you as you sit there topless. And nurses will think nothing of sending you down a hospital corridor with your buttocks on show, or expecting you to relieve yourself in a bedpan in front of your hospital roomies. Try not to be embarrassed – because they certainly won’t be.  

Find out more about ottonova’s expat health insurance packages

2. Honesty is the best policy

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Got bronchitis? Why on earth didn’t you come to the doctor sooner?  Don’t do regular exercise or eat fruit every day? Tut, tut, tut. Of course, bedside manner varies from doctor to doctor, but most are uncompromisingly frank, and it’s not uncommon to find yourself being reprimanded if your behaviour isn’t up to scratch. Suck it up – in Germany, the Götter in Weiß (Gods dressed in white) know best.

3. Things don’t always happen quickly

While German healthcare is generally regarded as being of good quality, the system can be slow, particularly if you have public health insurance. Don’t be surprised if you have to wait weeks or more for an appointment with a Facharzt (specialist), especially in big cities. For some foreigners (looking at you, Brits), this might make you feel right at home, but for others used to more efficient service, it takes some mental adjustment.

Taking out private insurance will help you get seen more quickly. For example, with ottonova’s health insurance you can consult an English-speaking doctor via video call, often with a waiting time of under a minute.

4. Hospitals aren’t hotels

Need a stay in hospital? Make sure you come equipped. Many hospitals don’t issue basics like towels, gowns, soap and other toiletries, so you’re expected to bring your own. If you find yourself in hospital after an emergency, you’d better hope you have a friend who can bring in your pyjamas quick-smart.

Make sure you’re covered with ottonova’s expat health insurance

5. Medical degrees are mandatory… for the patient

Well, not really. But it might feel like that at times, thanks to the German medical tradition of issuing diagnoses with their Latin names (a practice known as Fachchinesisch). It can be hard to prise more detail out of your doctor in layman’s terms, particularly if your German isn’t much better than your Latin, but don’t start worrying if they brush you off with “everything’s fine” – it’s likely that convoluted Latin term simply meant you’ve got a cold.

If your German – or Latin – isn’t up to scratch, ottonova’s 24/7 Concierge Service is always on-hand to offer further explanation. Mirabile dictu!

6. Spas aren’t just for fun

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The culture of going to a therapeutic spa (das Bad) is a long-standing one in Germany, with many people believing ‘taking the waters’ can help cure or prevent your maladies as much as any medicine. So much so that you might find your spa break is covered by your health insurance (always check first). Likewise, naturopathic and homeopathic remedies, massages and other natural cures are often covered — and are with ottonova’s health insurance for expats without any additional costs.

7. Prices won’t break the bank

Though healthcare isn’t free in Germany, costs are generally covered by your public or private health insurance, usually without a deductible, and are considerably cheaper than in other countries. So while the monetised nature of health may still be a culture shock for Brits used to receiving free treatment under the National Health Service, others, particularly US expats, may find themselves pleasantly surprised by how reasonable the cost of healthcare and medications can be in Germany.

In some cases, ‘going private’ may even be cheaper than public health insurance as the amount you pay for public health insurance depends on your income, so higher earners end up paying more. However, if you opt instead for private health insurance, the costs are calculated based on your current health status so could be even cheaper than public health insurance.

This content was produced by The Local Creative Studio and sponsored by ottonova.

For members


What you should know about Germany’s plans to roll out e-prescriptions

Germany is taking a big step towards a more digital-friendly health system, with plans to roll out e-prescriptions nationwide. Here's what you should know.

A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony.
A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

What’s happening?

From January 1st 2022, people in Germany will receive their prescriptions digitally (known in Germany as an ‘e-Rezept’) from healthcare providers.

Patients should be able to get their prescription from their doctor via a QR code sent to an app, which can then be transmitted to a pharmacy. The pharmacy can then let the patient know whether their medicine is in stock (or if they want to order it), and when it is ready for collection. 

This model is to be mandatory for people with statutory health insurance from the start of 2022, replacing the good old paper prescription.

However, the QR code can also be given to the patient by the doctor on a piece of paper if a patient does not have access to or doesn’t want to use a smartphone. 

READ ALSO: The changes around doctors notes in Germany you should know 

How exactly will it work?

In theory this is the plan – you’ll visit the doctor or have a video consultation. After the examination, the doctor will issue you with an electronic prescription for the medication that has been prescribed to you. 

A prescription code is automatically created for each ‘e-Rezept’, which you will need so you can get the medicine at the pharmacy. As we mentioned above, patients in Germany can either open this QR code in the free e-prescription app developed by Gematik and the Health Ministry, or receive it as a printout from the doctor. 

Next, you can take the prescription QR code (either in the app or as a printout) to your pharmacy of choice to get the medication needed.

One of the major differences and timesavers under the new system is that you can also select the pharmacy you want to get the prescription from digitally, order the medication (if needed) and you’ll be alerted when the prescription is ready. You can also arrange to have it delivered if needed. 

A doctor’s signature is not required, as e-prescriptions are digitally signed. 

The aim is that it will save on paperwork, time at the medical office and trips to the pharmacy. 

Some patients have already been receiving digital prescriptions. The ‘e-Rezept’ was tested out successfully in selected practices and pharmacies with a focus on the Berlin-Brandenburg region of Germany. The test phase started on July 1st this year.

Pharmacies and doctors’ offices nationwide have also been given the opportunity to test the new system from the start of December. 

“This will enable practice providers and pharmacy management systems to better prepare for the mandatory launch on January 2022 1st,” said, the official health portal site for German pharmacies

The new e-prescription app.
The new e-prescription app. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

READ ALSO: 10 rules to know if you get sick in Germany

There is some leeway though – if there are technical difficulties, paper prescriptions can still be issued in individual cases until the end of June next year.

The National Association of Statutory Health Insurance Physicians estimates that it could take until mid-2022 until all users are equipped with e-prescription applications nationwide.

The obligation does not apply to privately insured people from January next year. Private insurance companies can decide voluntarily to make the preparations for their customers to use the e-prescription.

What’s this about an app?

To be able to receive and redeem prescriptions electronically, people with statutory health insurance need the Gematik ‘das e-Rezept’ app. 

One issue is that the app appears to only be available at the moment in German app stores. We’ll try and find out if there are plans to change this and widen out the access, but it seems likely for that to happen. 

Germany’s Covid-Warn app, for example, was initially only open to German app stores but was gradually widened out to many others. 

As mentioned above though, those who don’t have access to an app will be able to use the paper with the code on it to access their prescriptions. 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

Has it all gone smoothly?

As you might expect, there have been a few hiccups. 

Originally, the introduction nationwide was planned for October but was postponed due to many providers not having all the tech requirements set up. 

Now though, more than 90 percent of the practice management systems have been certified by the Association of Statutory Health Insurance Physicians – a prerequisite to issue the e-prescriptions.

The e-prescription is part of Germany’s far-reaching plans to digitise and streamline the health care system.

The head of Gematik GmbH, Markus Leyck Dieken, recently spoke of a “new era” that is “finally starting for doctors and patients” in Germany. 

Useful vocabulary:

Prescription – (das) Rezept

Doctor’s office/practice – (die) Arztpraxis

To order – bestellen 

Pharmacy – (die) Apotheke

Video consultation – (die) Videosprechstunde