Well, the surprise of German teachers is understandable: in a country where everyone enjoys the benefits of insurance medicine, such an unexpected exception suddenly turned up. Of course, even without an insurance policy, no one will refuse help and will prescribe the necessary medicines. But the bill, which will then be kindly delivered by mail, may be such that even a healthy person will clutch at their heart. Not to mention complex cases when one has to spend a long time in a hospital bed or undergo a serious operation. You need considerable savings to pay such expenses out of your own pocket. That is why more than a thousand health insurance funds - as the institutions dealing with medical insurance are called in Germany - are by no means suffering from a lack of clients. Moreover, for any person working for hire, if their income does not exceed a certain amount, insurance is mandatory.
You will have to pay extra for luxury
The amount of the monthly contribution can vary significantly depending on where you are insured, and the level of services provided will also differ (not every fund will pay for treatment in a luxurious private clinic in Germany). But one thing will remain unchanged: your employer must add the same amount to what you contribute. Naturally, as with any other type of insurance, if injuries and illnesses have passed you by, then the money paid to the fund is, as they say, gone, which no reasonable person who has chosen a policy within their means will grieve over.
Although one acquaintance of mine, distinguished by enviable health, from time to time, during periods of financial difficulties, complained: 'Lord, why have I been paying several thousand a year to the health insurance fund for so many years? I should have saved that money.' But he fell silent as soon as you said to him: 'Wait, the time will come to put in new dental bridges and crowns...' After all, no one can avoid seeing a dentist, and the expenses for dental doctors and prosthetists are such that it is better not to go to them without the help of the fund.
However, medical insurance is by no means a cash cow ready to pay for all the whims of those who like to be treated. Moreover, the population of the Federal Republic of Germany is aging more and more, and even the richest funds are already finding it difficult to make ends meet. Therefore, 10 years ago, a partial reform of insurance healthcare was carried out. Since then, patients have had to pay extra for medicines that were previously simply issued on a doctor's prescription. True, the amount was not burdensome, and it was decided to charge it also so that people would not stock up on medications for future use: after all, expired medicines quite actively replenish the stocks of specialized waste that is difficult to get rid of.
Co-payments were also provided for hospital stays, rehabilitation courses, dental prosthetics, the purchase of expensive glasses, and the making of contact lenses (if the doctor did not indicate that this is the only possible way to correct vision). That is, only what is medically necessary was done through insurance, and everything else - 'third teeth,' as prostheses that look much better than some real ones are politely called here, or vaccinations needed for a vacation trip to Asia or Africa - you are welcome to pay for yourself.
Another important detail: a policy held by at least one working parent extended to the other spouse and to children until they reached the age of 18. Moreover, if they were unable to find work by that time, the term could be significantly extended - up to 23 years. And large families were given other indulgences. The needs of students were also taken into account: very small contributions were provided for them.
The demographic situation forces us
But the reforms carried out ten years ago proved insufficient. And starting this year, the German insurance healthcare system will have to undergo new transformations. What is the reason?
It lies not only, or more precisely, not so much in the difficult economic situation in which the German economy now finds itself, but in the inexorable demographic grip. Over the past 40 years, life expectancy in the country has increased by eight years, and the number of births has halved - to a modest 9.3 children per thousand people. In 2001, the republic had 51.1 million citizens of working age and 14 million people over 65 years old.
It seems not so scary. But the fact is that with such a birth rate, by 2050 the number of elderly will grow to 22.2 million, and the working-age population will fall to 40.7 million. In other words, for every elderly person, and therefore particularly in need of medical services, there will be only 1.8 working people. The conclusion is obvious: with such a scenario, payments to health insurance funds will become simply prohibitively high for them.
However, no one wants to give up compulsory medical insurance. On the contrary, the task is set to improve its quality. For patients, this will result in additional expenses. What kind?
For example, when visiting doctors (all specialties except the dentist, who have their own calculations), you will have to pay out of your own pocket a maximum of 10 euros per quarter. The frequency of visits is not limited. For a prescribed medicine, you will have to pay 10% of its cost, but not more than 10 euros per package. The same rule applies to hearing aids, crutches, wheelchairs and other auxiliary means. It is worth noting that even before, if you thought of buying a medicine at your own discretion, without a prescription, you had to pay 2/3 of its cost.
If you happen to end up in the hospital, the co-payment will be more substantial - 10 euros per day. True, the payment period is limited to 28 days a year.
There are two important restrictions in the new rules. According to the first, all possible co-payments cannot exceed 2% of your annual income. For the chronically ill, this threshold is twice as low - 1%. In general, the limit, called in German the 'upper limit of burden', is calculated in such a way that those with dependents are in an advantageous position.
Let's imagine that a certain employee, Herr Müller, who supports a housewife wife and three sons, earns 26.400 euros a year. From this amount, 3.648 euros will be deducted for each of the children and 4.347 euros for the wife. From the remaining 11.109 euros, we subtract 2% and get 222 euros a year. Such is the "upper limit of the burden" for the Müller family, taking into account medical care for all four people. And if Herr Müller lived as a bachelor, then he would have to agree that the total amount of annual additional payments for medical care would be 528 euros. That's social justice.
What obligations do health insurance funds now refuse to assume at all?
First, payment for medicines not prescribed by a doctor and such medications whose use is not a vital necessity, say Viagra. Second, they will not pay bills for certain types of surgical intervention, such as sterilization, not without reason believing that family planning measures are strictly a personal matter.
As for artificial insemination, insurers will bear 50% of the costs. Moreover, as in some sports, only three attempts are provided: all others - at one's own expense.
Third, bills for the manufacture of spectacle lenses will no longer be paid, and transport costs will not be reimbursed, as was previously done in cases where outpatient treatment was required. Naturally, no one encroaches on the holy of holies: payments for temporary disability, simply put, due to illness, will remain the unconditional obligation of insurance funds.
The development of a bonus system for those who monitor their health, regularly undergo check-ups and do not neglect early diagnosis of diseases, is left to the discretion of each specific fund. This is a matter of healthy competition.
Let us note once again: everything we have discussed pertains to compulsory health insurance. Of course, everyone is free to voluntarily pay any acceptable amount so that the health insurance fund can offer a wider range of services if necessary. In this respect, health insurance is no different from, say, car insurance.
Generally speaking, from conversations with my German friends, I concluded: although the policy naturally costs money, its expediency is not questioned by anyone. Of course, a truly even distribution of burdens will not be achieved, no matter how hard one tries, and the healthy will always pay for the sick, the young for the old, the working for the unemployed, and the wealthier for the poorer.
But then, if rare cases are excluded, no one is left without help, and costs are sought to be made affordable for all categories of the population. The absence of a strict "place of residence" tie-in allows patients to choose their attending physician themselves and, if necessary, consult with several doctors. So if you want to be healthy, get insured.