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‘It works’: Your verdict on the German health insurance system

Getting to grips with German health insurance can be tricky for foreigners. We asked readers what they think about it, and what improvements they'd like to see.

Walkers and runners under cherry trees in Berlin.
Walkers and runners under cherry trees in Berlin. What do people think about the health insurance system in Germany? Photo: picture alliance/dpa | Bernd von Jutrczenka.

Along with registering as a resident, another task you have to check off when you move to Germany is setting up health insurance. 

In fact since 2009, getting health insurance has been a legal requirement for every person with a permanent place of residence in Germany.

Most people in Germany – around 86 percent of the population – are part of the statutory public healthcare system (Gesetzliche Krankenversicherung, GKV). It means that contributions are split between the employer and employee, and are deducted from employees’ salaries automatically.

People with private healthcare insurance (Private Krankenversicherung, PKV) usually pay contributions to the health insurance firm directly. 

In our recent survey on attitudes to German health insurance, almost 87 percent of around 40 respondents said they were insured via the statutory system. 

But just how does the whole system stack up in the eyes of foreigners?

READ ALSO: The three new services covered by health insurance in Germany

‘As good as the best’

Our readers painted a mixed picture. But most of the respondents to our survey – 65.8 percent – said they were largely satisfied with their German health insurance provider, while 23.7 percent said they were not happy. Just over 10 percent said they weren’t sure. 

David, 74, in Hechingen said the German health insurance system works well. “I have lived in the UK, the US, NZ and various other EU states,” he said. “The German system is as good as the best. Much better than the US system, less creaking than the UK NHS.”

Another reader Rebecca, 49, who is based in Berlin, praised the system. 

“I recently had to be referred to see a consultant and it was quick and easy,” she said. “I can also get doctor’s appointments relatively quickly.”

A doctor's waiting room.

A doctor’s waiting room. Photo: picture alliance/dpa | Daniel Karmann

Others took a slightly less enthusiastic view.

Eric Cloutier, 40, in Berlin said: “Like everything in Germany, (health insurance) is needlessly involved, comically bureaucratic, and involves a mountain of paperwork in the year 2022, but… it works.”

Some respondents said the system was a lot better for people in employment, but was stressful and expensive for the self-employed. 

Rosemary Hardy, 72, in Hamburg, said: “It’s fine as long as you’re employed, but the minute you turn freelance it becomes a bureaucratic nightmare.”

Another reader said they wished Germany had a system more like the NHS in the UK, which is free to access at the point of contact. 

Thumbs up for English-language services

One theme that came up a lot was services in foreign languages. Some of the larger Krankenkassen , such as Techniker Krankenkasse (TK) and AOK, offer advice in English. 

Andrew Walker, 53, who lives in the Karlsruhe district, said: “TK has English speakers accessible by phone. They helped me navigate the system when I needed an urgent specialist appointment.”

He gave the health insurance system the thumbs up but said: “It is more expensive than many think, especially if you are a freelancer”.

For a 29-year-old reader in Berlin, the struggle to find an English speaker has been difficult. 

“Being an international guy, I need an English-speaking partner, but AOK always says their special English-speaking staff are busy,” he said.

On its website, AOK says it offers 24/7 “expert English-language support”.

Several readers urged health organisations to expand their English advice service.

Jaton’ West, in Berlin, who is with private insurer DKV, said: “As a foreigner, it would be helpful if they offered support in English. They were perfectly happy to converse with me in English when selling me the policy, but not in giving me service. Since it is a private insurance, that means there’s a greater likelihood that they will have foreign customers and many speak English, so it would be useful.”

A 42-year-old in Frankfurt also said he’d like to see all health insurance apps enabled so that they can switch to English as well as German. 

Wlademir, 32, in Offenbach said he would like to see “more services and more English providers”.

What doesn’t work about the health insurance system in Germany?

Several respondents said they were unhappy about the access to services through insurance.

One reader flagged up how hard it has been to get mental health support with their insurance. 

READ ALSO:

Others mentioned gender issues – for instance contraception is generally not covered by insurance in Germany because it is viewed as a lifestyle choice. 

“I paid hundreds of euros for my IUD, and am just about to pay 50 for an internal ultrasound due to pain, additionally I have to pay for a pap smear screening,” said one reader.

A health insurance card.

A German health insurance card. Photo: picture alliance/dpa/BKK Mobil Oil | gettyimages/Lothar Drechsel

Luna, 41, in Berlin who has private health insurance, said women’s healthcare in Germany was “shockingly conservative”.

“I am required to use a plan with maternity cover (I’m child-free by choice), yet birth control is not covered and I have to pay out of pocket for that because it is considered a lifestyle choice,” she said.

“It has a more expensive monthly premium than the plan without maternity cover. Isn’t having a child in today’s world just also a lifestyle choice? I’m a non-EU citizen on a visa, and was told I was required to have the maternity cover included in order to qualify for a visa renewal. So I am paying a little extra each month and also for my contraception.”

READ ALSO: Do Germany’s planned changes to abortion laws go far enough?

Albina, 29, in Hamburg said the queues for getting appointments with specialists were too long and “doctors don’t prescribe medicine very willingly”.

A few other readers said they couldn’t work out why some services were not covered by health insurance.

“I don’t understand how they decide what should and shouldn’t be covered by insurance. You pay so much health insurance that you expect basic things like treatment for skin infections to be covered,” said a 33-year-old reader in Frankfurt. 

One reader said he wished basic health insurance included dental cover. 

What else could be improved?

Along with the points already mentioned, a few readers said they would like to see more holistic services.

Eric Cloutier, 40, in Berlin said: “Evolve a little to include some of the more holistic things, but also expand in to acupuncture and osteopathy a bit more.”

Andrew in Karlsruhe also wants to see improvements: “It is still lagging behind in its accessibility online and non-traditional means. It’s very hard to get access to health records using the TK system and I’ve heard its no better with other providers.

READ ALSO: Why more than 20 million people in Germany face higher health insurance costs

According to readers, public insurance works better than private, particularly because private insurance can end up being super pricey in the event of illness or as you get older. 

And once more, the issue of paperwork cropped up being a problem.

A 35-year-old in Berlin said: “Private insurers do not have the level of integration that the public ones have. If you have a private health insurer, you have to do a lot of invoices back and forth.”

Dell, 30, in Nuremberg said public health insurance works well because it doesn’t “break your bank”.

“Also private health insurance will be very costly,” he said. “So it is very wise to stick with public health insurance if you want to live Germany for long term.”

Judy, 73, Rheinland-Palatinate said there are positives to being private but in the end it is very expensive. 

“If you are not privately insured, waiting times to see specialists are incredibly long,” she said, adding that it is “almost impossible” to change over to the public system if you are private. 

“This possibility (to change) is urgently needed as the rates for private insurance rise every year,” she said. 

*******

Thanks to everyone who shared their experience with us. Although we weren’t able to include all the submissions, we read each of them and are sincerely grateful to everybody who took the time to fill in the survey.

If there’s anything you’d like to ask or tell us about our coverage, please get in touch.

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READER QUESTIONS

Reader question: Is abortion illegal in Germany?

Reproductive rights are in the spotlight this week as the US debates possible landmark changes to abortion law. Here's what you need to know about abortion in Germany.

Reader question: Is abortion illegal in Germany?

A leaked document earlier this week claimed that the US Supreme Court is in favour of overturning a landmark 1973 ruling, called Roe v Wade, that made abortion legal in the USA.

The news has put a further spotlight on reproductive rights around the world. Readers of The Local have contacted us to find out about the laws on abortion in Germany. We spoke to campaigners for women’s reproductive rights to help explain what you need to know.

Is abortion illegal in Germany?

It may surprise many people to know that abortion remains technically illegal in Germany, but there are circumstances in which people can end a pregnancy without facing any legal consequences. 

The exceptions include: the abortion being performed within the first 12 weeks of pregnancy, and following mandatory counselling carried out at least three days before the procedure to terminate the pregnancy.

If there is a medical reason for an abortion, then it is not unlawful. This applies, for instance, if the pregnancy poses a danger to the life or physical and mental health of the woman. An abortion can also be carried out if tests identify that the foetus is disabled or seriously ill. Late abortions (after 12 weeks) are allowed if these special factors apply. 

Abortions are also legally possible if they are the result of a criminal act – for example if the pregnancy is the result of rape. 

The termination of a pregnancy is known as Abtreibung or Schwangerschaftsabbruch in German. Around 94,600 abortions were reported in Germany in 2021, according to official figures. 

The rate of abortions per 1,000 women in Germany stands at 6.8 – one of the lowest in Europe alongside Switzerland. The rate of abortions stands at 19 per 1,000 women in Sweden, 17 in the UK, 16 in France and 16 in the US.

People who choose to get an abortion in Germany generally have to cover the costs of the procedure themselves. 

According to the German Centre for Foreign Feminist Policy, which published information by Medical Students for Choice Berlin, abortion in Germany can cost between €200 and €650 depending on the methods involved. People can apply for financial help from their health insurance.

READ ALSO: Is abortion legal in Switzerland?

A pro-choice counter protester at the "March for Life" demo against abortion in Berlin in September 2020.

A pro-choice counter protester at the “March for Life” demo against abortion in Berlin in September 2020. Photo: picture alliance/dpa | Jörg Carstensen

Tell me more about abortion laws in Germany…

There has been a lot of discussion about abortion in Germany in recent years. Germany’s traffic light coalition – made up of the Social Democrats, Free Democrats and Greens – recently announced plans to scrap paragraph 219a – a controversial clause on advertising abortion that has remained largely unchanged since it was brought in by the Nazis in the 1930s.

It has meant that doctors in Germany have been unable to advertise that they carry out abortions, and detail what methods they use – and has even resulted in prosecutions, such as the high profile case of Kristina Hänel, a doctor from Giessen in western Germany.

Getting rid of this paragraph should pave the way for more accessible information on abortion in Germany.

READ ALSO: Do Germany’s planned changes on abortion go far enough?

But abortion in Germany is still regulated by paragraph 218 of the criminal code, which dates back to 1871. Although the law has been amended to allow for exceptions, pro-choice campaigners in Germany want to see abortion fully legalised. 

Dr Alicia Baier, chairwoman of campaign group Doctors for Choice, said the German coalition government’s plans to get rid of paragraph 219a were a step forward.

But she said much more action was needed – including removing abortion from the criminal code. 

“I think German abortion laws are behind the times,” Baier told The Local. “There are many European countries which regulate abortion outside the criminal law. But in Germany we still criminalise abortion, we still have the obligatory waiting period, and obligatory counselling.”

Baier said abortion didn’t belong in criminal law. “That’s not the place for abortion, it should be regulated in some other law. Like in France – they regulate it in the public health law.”

Although the coalition government has said it wants to set up a working group to look at options for regulating abortion “outside of the framework of the criminal code”, there doesn’t seem much political appetite for big change.

Earlier this year, Katrin Helling-Plahr, FDP parliamentary group spokesperson for legal policy, told The Local: “We Free Democrats are of the opinion that Paragraph 218, as the result of a long societal discussion, represents a successful compromise with regards to protecting the life of the foetus and the right to self-determination of the pregnant person.”

Campaigners at the pro-life 'March for Life' in Berlin in September 2021.

Campaigners at the pro-life ‘March for Life’ in Berlin in September 2021. Photo: picture alliance/dpa | Paul Zinken

Is it difficult for women in Germany to get an abortion in practical terms?

According to campaigners, it can be hard for people to find information on terminating pregnancy and doctors to carry it out depending on where they live.

“I think it really depends on the women themselves and where they are,” campaigner Annika Kreitlow, a research assistant with the Centre for Foreign Feminist Policy, told The Local. 

“I think in Berlin it’s okay – there are a lot of doctors in Berlin and a lot of progressive people move to Berlin. But if you live in the south of Germany, like in Bavaria for example, there are cities which don’t have any doctors who provide abortions at all.

“In the northern islands of Germany, people there also have to fly to the mainland to get an abortion – sometimes they have to travel 200 or 300km to get an abortion.”

Kreitlow also said people in Germany face additional barriers because of the mandatory counselling and three-day wait. 

“You have to be really consistent on finding a doctor who will do that before the 12th week. It depends on the region and also how much knowledge the person has on the situation,” she said. “If you’ve never come into contact with this and don’t know anyone who’s had an abortion, there’s a lot of fake information out there and fake websites.”

She said it’s more difficult for non-Germans.

“If you’re not a native German speaker and you come from somewhere else, it’s also very different to find the right information and distinguish what is real information and what is fake, who to trust and who to talk to,” Kreitlow said. “It’s a very difficult situation but a lot of circumstances make it even more difficult in Germany.”

How do the laws affect doctors?

Dr Baier said there was still a “big stigma” surrounding abortions in Germany – including in the medical profession. Although it is one of the most common gynaecological procedures, it is often hardly discussed at medical schools in Germany.

“In many universities – during six years of study – it’s not mentioned at all, or it’s mentioned in the context of medical law or medical ethics,” said Baier.

“It’s still very taboo in medicine. We wish it was acknowledged as part of medicine because it’s a medical procedure. In Germany, only doctors are allowed to perform them. If we don’t do it, people are left alone and that could cause a lot of health risks.”

Baier said the barriers for women in Germany looking to get an abortion, or for information on it, need to be urgently worked on.

“In some regions of Germany it’s catastrophic and people are treated very badly,” she said. “We have a modern health system but it doesn’t correspond to that at all in this area.”

 

Is there a large pro-life movement in Germany?

There’s a sizeable number of campaigners who are against abortion in Germany.

Pro-life events such as Marsch für das Leben (March for Life) take place every year in Berlin. In 2021 around 4,500 people attended the march, demonstrating against abortion and euthanasia laws. Counter-demonstrators from the pro-choice movement also march on the days of these events. 

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