Health care in Germany

There are three areas of health care in Germany, depending on the type and severity of an illness. People who have an acute illness usually go to a doctor's practice first – typically a family doctor (Hausarzt), or less often a specialist (Facharzt). But sometimes they need treatment in a hospital instead. For longer-lasting illnesses, outpatient or inpatient rehabilitation treatment may be needed.

The German healthcare system is made up of many different healthcare providers and facilities. The legal framework is set by the government. On top of this, numerous organizations and groups manage the health care itself – like associations and representatives of health insurers, of various healthcare providers and professions, and patient organizations.

Public health insurance (gesetzliche Krankenversicherung) is regulated by law. Also known as "statutory" health insurance, it is one of the five branches of social welfare in Germany – along with statutory accident insurance (Unfallversicherung), pension funds (Rentenversicherung), unemployment insurance (Arbeitslosenversicherung) and long-term nursing care insurance (Pflegeversicherung). The legal basis of these five branches can be found in the German Social Code (Sozialgesetzbücher, or SGB).

Health insurance is compulsory in Germany, so everyone who lives in this country must have health insurance. The aim is to ensure that no one runs into financial difficulties due to an illness. If you're insured, you typically pay none of the treatment costs – or only a reasonable part of them – yourself and also have more financial security if you're unable to work.

Employees with a gross annual salary below a specific level must have public health insurance. If you earn more, you can choose to have private insurance instead. People with certain professions, like public officials, have this option too.

People from other countries who work in Germany generally have to get German health insurance as well – even if they live in a different country. People who want to study in Germany will also have to prove that they have health insurance. Depending on which country you come from, your health insurance there might be accepted in Germany – for example, if it's from another European Union (EU) member state. If not, you have to join a health insurance provider in Germany or get a special kind of travel health insurance.

Health care is mostly financed through the regular insurance payments made by people with health insurance and by their employers. Known as a "premium," the amount you pay is determined solely by your income level. But everyone with public health insurance is entitled to the same health care – regardless of how much they have paid into the insurance fund.

A treatment is considered to be outpatient care (ambulant) if you can go home afterwards and don't have to stay overnight. In Germany, outpatient treatment is mainly provided in the practices of doctors, dentists, psychotherapists and other healthcare professionals.

You can decide for yourself which practice you want to go to. Most medical and dental practices have what is known as a “Kassenzulassung” (public health insurance accreditation). You can often recognize them by the words "Alle Kassen" on the sign outside their practice. These accredited practices generally have to treat anyone who has health insurance. Private practices, on the other hand, do not have to treat people who have public health insurance – or they only have to do so in emergencies. They only treat privately insured people, or people with public health insurance who pay for the treatment themselves.

When people are ill or need medical advice, they usually go to see their family doctor (Hausarzt) or pediatrician (Kinderarzt) first. That doctor will decide whether you also need to see a specialist.

If you do, you will be referred to a specialist, such as a gynecologist or a dermatologist. But you can usually go straight to a specialist or psychotherapist without seeing your family doctor first.

As well as doctors, there are also other healthcare providers. These include physical therapists, speech therapists, nurses and midwives. You will usually need a doctor’s prescription for things like physical therapy, speech therapy and nursing care at home.

If you go to an accredited practice, your treatment will be billed directly to your health insurer. For this to be possible, you will need to take along the electronic health insurance card that you got from your health insurer. The public health insurers pay fixed amounts for some services, such as high-quality dental prosthetics. You have to pay for any additional costs yourself (out-of-pocket). The exact amount you need to pay will depend on the type of dental treatment you choose. Adults also usually need to pay part of the costs of special therapies known as "Heilmittel" – like outpatient physical therapy or speech therapy.

Privately insured patients generally pay for their treatment themselves at first, and are then reimbursed by their insurer once they have sent the bill to their insurer. The level of reimbursement will depend on the individual insurance policy.

Doctors keep important documents (like medical findings and doctor's letters) in their health records for you. You can usually look at these documents if you ask to, and will be given photocopies or printouts on request. Doctor's practices have to give you these copies for free the first time you ask for them. If you would like more copies after that, you may be asked to pay a small fee. People with public health insurance can now also choose to make use of their own personal electronic health records (elektronische Patientenakte, or ePA). The idea is that digital versions of all the important documents from different doctor's practices or hospitals will eventually be kept together in one place.

Most hospitals in Germany treat all patients, regardless of whether they have public or private health insurance. Your family or specialist doctor will decide whether you need hospital treatment and, if you do, refer you to a hospital – unless it's an emergency situation. Then you can go straight to the hospital yourself or call the emergency services. Treatment that allows you to return home on the same day is referred to as “outpatient” care (ambulant). “Inpatient” care (stationär) refers to treatment where you have to stay overnight in the hospital. People who have public health insurance have to pay 10 euros per day towards their accommodation and meals if they stay in the hospital.

Rehabilitation centers offer treatments that last from a few days to several weeks. These treatments are designed to help you become independent and stronger again after a severe illness or after surgery. The possible goals of rehabilitation include being able to return to work or live a more independent life again – or preventing a chronic illness from getting worse. Depending on the situation, you either stay at a rehabilitation center (inpatient rehabilitation) or go in for treatment every day without staying overnight (outpatient rehabilitation).

There are also rehabilitation centers for people who have mental health disorders or addiction problems.

Medication is available in pharmacies, where you can also seek advice and information on medications. If your pharmacy is closed, you will find a list at the entrance directing you to the nearest pharmacy that is open "out-of-hours" (Notdienst Apotheke) – in other words, at night and on weekends as well. You can look online for your nearest open pharmacy, too. There are also online pharmacies where you can order medication and they send it to you by post. They generally offer to give personal advice on the phone or via email, but that service isn't always available when you need it.

There are different categories of products in pharmacies:

• Prescription medications: You can only get these if a doctor has prescribed them for you. Then you will have to pay a small amount of the cost yourself, known as a co-payment (Zuzahlung in German). Your public health insurer will usually cover the rest. The co-payment is between 5 and 10 euros per medication. No co-payments are needed when medication is prescribed for children and teenagers under the age of 18.
• Over-the-counter (OTC) medications: You can get these without a prescription from a doctor. Examples include low doses of painkillers like ibuprofen or acetaminophen (paracetamol) as well as certain medications for the treatment of colds or allergies. You usually have to pay for them yourself. If over-the-counter medications are prescribed for children under the age of 12, public health insurers cover the full costs.
• Health products that are also available elsewhere: These products don't have to be bought in pharmacies. You can get them in places like drugstores, too. Health insurers do not pay for them. Examples include certain vitamin supplements or medicinal teas.

If you're privately insured, you will normally have to pay the full cost of medication yourself at first, and then your insurer will reimburse you afterwards. Some private health insurers also cover the costs of over-the-counter medications.

In an emergency, you can go straight to the emergency department (Notaufnahme) of a hospital or call the emergency services. There are various free telephone numbers for medical emergencies. You can reach them around the clock:

• 112 – Emergency call (Notruf): in life-threatening situations – for example, severe injuries after an accident, extreme blood loss, breathing difficulties, loss of consciousness, or signs of a heart attack or stroke. Then the emergency services will send an ambulance or a paramedic (Notarzt). If you're not sure whether it's a life-threatening situation, you should call 112 anyway.
• 116 117 – Doctors' information hotline (ärztlicher Bereitschaftsdienst): For urgent, but not life-threatening, situations if your doctor's practice is closed and you can't wait until the next day – for example, if you have a high fever, severe pain or have been vomiting a lot. They will give you medical advice and perhaps recommend that you see a nearby on-call doctor, letting you know which doctor that would be.
• Poison emergency number (Giftnotruf): If you're concerned about possible poisoning – for instance, if you have taken too much of a medication, swallowed a cleansing product or eaten mushrooms that you're not sure about. There are different phone numbers for different regions of Germany. They are listed on the website of the Federal Office of Consumer Protection and Food Safety (BVL). The person you talk to there will give you first aid instructions. If you think it could be a life-threatening situation, you must call 112 first!

There are also telephone hotlines for people who need help for mental health problems or emergencies:

• 116 123: Telefonseelsorge (a crisis helpline, German-speaking)
• 116 111: Nummer gegen Kummer (helpline for children and teenagers, German-speaking)
• You will find a list of crisis helpline numbers for other languages on the Telefonseelsorge website.

You can also call a helpline if you're worried about someone else and don't know how to help them.

If there's an acute risk of suicide, you can call 112. Alternatively, you can contact a psychiatry and psychology (psychiatrisch-psychotherapeutische) practice that is on "out-of-hours" duty, or the emergency outpatient services of a psychiatric hospital.

There are a wide variety of different services in Germany that offer personal advice and other forms of support if you're ill: These include support groups, the Independent Patient Advice Service (UPD), psychosocial information centers, and information services provided by the public health insurers and departments.

You will find information and leaflets on various health topics (specially for immigrants, in many different languages) on the Federal Ministry of Health's website "Migration and Health".

When choosing between different treatment options, it's often also very helpful to talk to other people who are in a similar situation. It is not always easy to decide. To make the right decision for you, it's important to have reliable information.