At the hospital

If you don't need emergency treatment and can plan your stay, there's time to look for information on different hospitals. Web-based summaries of quality reports for different hospitals can be useful here. These specialized search engines can help you find different types of information, such as which fields of medicine a particular hospital specializes in or how often they perform certain types of surgery.

You will also find a list of links to healthcare providers in Germany, along with explanations, on the website www.eu-patienten.de. This website, run by the National Association of Statutory Health Insurance Funds in Germany (GKV Spitzenverband), includes information for EU citizens who would like to have treatment in Germany.

The costs of medically necessary treatments are covered by all statutory health insurers. Then the hospital bills your insurer directly.

Anyone over the age of 18 who has statutory health insurance will usually have to pay the hospital ten euros per day for accommodation and meals – but only up to a total of 28 days per year.

Any additional services – such as treatment by a head doctor ("Chefarzt") or a private room – will be stipulated in a contract with the hospital ("Behandlungsvertrag") before treatment starts. You will then be asked to also sign an extra agreement ("Wahlleistungsvereinbarung") specifying the elective services. If you don't have supplementary private insurance coverage for services you have requested, you will have to pay for them yourself.

Procedures that are not medically necessary, such as cosmetic surgery, are not covered by statutory health insurance. A co-payment must be made if treatment costs arise later due to complications.

If you have private insurance, your hospital treatment bills will be sent directly to you. You can either pay the hospital directly and be reimbursed by your insurer later, or forward the bills to your insurer, who will then pay the doctors or hospital.

The main documents you will need in order to be admitted to the hospital include the following:

• Your health insurance card if you have statutory health insurance. If you have private health insurance, you may also take a statement from your insurer guaranteeing coverage instead.
• Referral from your family doctor or a specialist
• Passport or identification card

The following documents and information may also be helpful:

• X-rays, lab results or medical reports from any previous examinations
• Name, address and telephone number of your family doctor
• Name and telephone number of close friends or family who should be contacted in case of emergency
• Your medication schedule, and – as a precaution – enough medication for the first 24 hours in case it's not readily available at the hospital
• If you have them: Documentation of allergies, blood group, vaccinations or x-rays, and any other special documentation for things like blood thinners (anticoagulants), a pacemaker or artificial heart valves, and a record of your blood sugar levels if you have diabetes.

Nursing staff will show you to your room and tell you what you need to know about your stay at the hospital. They will ask about what medicine you take, and if you have any special dietary preferences or needs.

Mobile phones are now allowed in most hospitals. You may want to double check whether there are some areas where their use is not permitted.

You will come across many people while at the hospital, including doctors and nursing staff responsible for your medical treatment and nursing care. Every hospital is also staffed with social workers, psychologists, nutritional specialists, physiotherapists, pharmacists and other medical professionals. It may be difficult to keep track of who everyone is, so do not hesitate to ask who you're dealing with if you're not sure.

The first part of your treatment includes a talk with the hospital doctor and an initial physical exam. Because the hospital doctor doesn't know you that well, it's important for you to be open with them and to provide a complete account of your symptoms and medical history. Some hospitals will also have you talk to a hospital pharmacist about the medication you take. The ward doctor ("Stationsarzt") is the person you will have most personal contact with during your stay in the hospital. Ward doctors regularly confer with the senior doctors and the head doctor.

You will usually have a daily visit from the doctors, during which they will talk with each other and with you about how you are feeling and how your treatment is going. Nurses will come to see you several times a day, and they are important contacts too. They also have an important role in coordinating everything that happens in the ward.

If your surgery is planned long enough in advance, the hospital will often give you an appointment for a pre-operative assessment. This will usually involve some basic tests, like an ECG (electrocardiogram to check your heart activity) and further x-ray or ultrasound scans. Depending on your health and the type of procedure that is planned, you may be able to donate your own blood (autologous blood donation). This involves repeatedly giving blood at different times in the weeks leading up to the operation. If you then need a blood transfusion during surgery, doctors can use your own blood for the transfusion.

Before surgery, the surgeon and the anesthesiologist will talk to you about the surgical procedure, the anesthetic and any possible risks.

After they have spoken with you, you will be asked to sign a consent form ("Einverständniserklärung") verifying that you agree to the procedure and the risks. It is important that you only sign if you have clearly understood everything and are convinced that the benefits of the procedure outweigh the risks. Ask them to explain medical terms or anything else you don't understand. If you have difficulties understanding German, you may want to bring along someone who can translate for you. It is possible to ask for a professional interpreter, but you will have to pay for this service yourself.

You will need more information before having surgery and will also have to make some preparations. For instance, it's important to know when you need to stop eating and drinking or whether you have to take a sedative a few hours before the procedure. The part of your body where the surgery will be performed often needs to be shaved. It's best to ask up front what you will need to know after surgery. Always let someone know if you're in a lot of pain or have something else is worrying you.

Many hospitals offer social services for dealing with personal and legal issues. You might need rehabilitative treatment after surgery, or have to have someone care for you at home for a while. Older, very ill patients may have to go to a nursing home. Social services can then help to gather and fill out the required forms, to arrange for placement in a rehabilitation center, to organize household assistance for families or to help find a room at a nursing home. They can also help apply for financial support from the social welfare office, federal employment agency or nursing care insurance. Last but not least, you can also talk to social services staff about personal problems and they can help you to cope with your condition and its consequences.

Specially trained chaplains offer pastoral care for people facing serious illness or death. They also attend to the needs of people who belong to a different religion or who are not religious.

Hospitals are required by law to prepare for patients to leave the hospital and to ensure that they receive sufficient care afterwards. All of the measures involved in this step must be discussed and agreed upon with you. Your family members can also be involved in this if you prefer.

After leaving the hospital, you will usually receive further care from your family doctor. In some cases you will also need to go back to the hospital for follow-up appointments. You usually won't have to stay the night in the hospital for this, though.

Before you leave the hospital, you will be given at least a brief letter of discharge for your family doctor, containing the essential information about your diagnosis, your hospital treatment and possible further treatment. A few days or weeks later, you will receive a more detailed medical report in the mail. This will include the results of any special examinations, as well as x-ray or ultrasound images.

Medical staff may also give you or prescribe a small amount of medicine for you to use in the days after you leave the hospital. In some hospitals, the hospital pharmacy prepares a medication schedule for you to follow. If you need special medical aids or other treatments, such as crutches or physiotherapy, the ward doctors will give you a prescription.

The hospital can also issue paperwork saying that you are unable to work for the first week following your discharge. Ask if there is anything you need to pay attention to or do at home, like follow a special diet or avoid sports activities.

If you're not yet ready to care for yourself at home once you have left the hospital and still need nursing care, the hospital will prescribe at-home nursing care. This is also covered by statutory health insurance, usually for a period of up to four weeks.

Should you end up needing nursing care for longer than that, the hospital can contact the appropriate nursing care insurance fund, with your consent. Your need for nursing care will be assessed by a specialist from the German Health Insurance Medical Service (MDK) so that further nursing care can be organized.

If you have private health insurance, you can expect to receive one or more bills from the hospital’s head doctors. You then have to submit these bills to your insurer.