A couple of reasons why German healthcare is in such a mess

From some of the highest drug prices in Europe to bloated bureaucracies, there must be a dozen reasons why healthcare in Germany is an expensive mess – about 8% of gross wages for those on the public plan, and rising.

trust me i'm a doctor buttonA few years ago, during what turned out to be the longest stretch I’ve ever had to endure in a hospital, I got a good look at two of those reasons.

It started out as a routine blood test at my family doctor.

“This doesn’t look good” he says when showing me the results.  “You’ve got to see a specialist about this as soon as possible.”

So I get an appointment at a specialist who performs an ultrasound, along with another blood test.   When the tests come back he hums and haws, says it could be this or that, but to find out for sure, we have to take a tissue sample.  Jab a hollow tube through my liver and rummage through what they pull out.

“Just a couple of nights in the hospital,” he tells me.

I get sent to a third doctor, the one who’s going to be taking care of the hospital visit, who performs the third blood test in about three weeks, which comes back with the very same results.

Upon admission to hospital a couple of weeks later, they take another two blood tests, one on admission, another the next day.

“Look,” I tell them.  “I don’t understand.  I’ve got an arm like a junkie’s with all these needles.  Why do I have to get a new blood test every time I’m sent to a new doctor?”

“Because that’s the way we do it here,” they tell me. “You may be referred to another doctor, but they have to take a new test each time.  They can’t take the results of the former doctor at face value.”

I wondered how many billions each year are wasted that way, but it was the hospital visit itself that really opened my eyes to the way the system is set up to rip us all off.

Not only did they only perform the tissue sample the morning of my third day after admission, already forcing me to stay one more night than I’d planned for, but they also arranged to have me undergo a colonoscopy a few days later, because the tissue sample showed nothing abnormal, and they wanted to “make sure we aren’t missing anything.”

That was on a Friday, and they told me I’d have to spend the entire weekend in the hospital waiting for the colonoscopy to get underway the following Tuesday.

What?  Wait f0ur full days in hospital when I feel perfectly healthy just to prepare for another procedure that might not even be necessary?

“Screw you,” I told them.  “I am not spending five minutes in this dump more than I have to.”

Dump?  More like an asylum.  My time until then had been spent enduring the ravings of an attention-starved recovering alcoholic in the bed beside me, who, completely oblivious to the impact his constant ramblings and interruptions had on the rest of us, actually woke me up the night before the tissue sample, because he couldn’t sleep and so was watching his personal TV at 3 in the morning.  Mostly to get away from him, I packed up and left that Friday afternoon, signing a waiver on my way out saying that whatever happened to me that weekend was my own doing.

After a beautiful weekend hiking the storm-swept mid-winter beaches of St-Peter-Ording with K and the little red-haired girl, I showed up Monday morning at the hospital, spent a day drinking gallons of some vile solution turning my backside into a storm drain, submitted myself to an invasion by a 12-foot black plastic snake, and spent a day and a half recovering.  The only thing I was grateful for was their generous application of Demerol.  I liked it so much, I’d have let them do it again just to get more of the stuff.

I told my family doctor all this and he replied with what I’d been thinking all along.  “I’m really sorry you had to go through all that, but hospitals do that all the time..  Every night you stay there is worth a lot of money to them.  They maximise the time you have to stay so they can turn around and bill the health funds.  There’s really nobody checking to see if what they do is really necessary.”

To top it all off, I received a bill from the hospital for the daily user fee we all have to pay.  They completely disregarded the two nights over the weekend I had left the hospital, billing me for the full nine days.

I paid for seven with a note and a letter explaining why, with proof I wasn’t there and all the rest, but the bureaucrats ignored it.  Instead I received a nasty notice threatening me with legal action and all associated additional costs if I didn’t buck up for the two days I did not stay in their comfortable surroundings.

So I paid for those two days just to get them out of my hair, only to find out a few weeks later from my healthcare people that I shouldn’t have, and that I could get the money back if I applied for it.

But by then I was so glad to have the whole sorry mess behind me I didn’t bother.

18 Responses to “A couple of reasons why German healthcare is in such a mess”

  1. March 9, 2011 at 1:29 am

    You know, I’m not much of a ranter, but this is an issue where I could rant. I’ll spare you.

    I will say that, with a 93-year-old mom in tow, I’ve had plenty of opportunity to check out our own system, and two things are clear. (1) It’s set up to do to us pretty much what your system did to you, and (2) there are a good number of doctors and nurses who “work the system” to keep the worst abuses at bay. At least, to the best of their ability.

    I’ve paid medical bills that weren’t owed just to get the system off our backs, too. It’s rather telling that when I think of the health care system rather than individual physicians, techs, therapists and nurses, one of the words which comes to mind is “extortion”.

  2. March 9, 2011 at 5:03 am

    Sorry to hear about your aggravation. I hope you are completely well now.

    I always put it down to Teutonic caution. So far, we’ve only had kids in hospital here with extreme kid-like illnesses (vomiting, weird allergic reactions, concussion) so we’ve always been grateful for the cautiousness we’ve seen, however I can imagine as an adult it must be deeply frustrating. Our last visit was for the removal of tonsils – a six-day affair – and the woman in the bed next to our kid watched TV of the worst kind till midnight every night.

  3. March 9, 2011 at 9:10 am

    Sheesh, how ridiculous. This is one of the reasons why I stay away from doctors as much as possible. Seems like most of the places you end up are more interested in your money than your health. Sad state of affairs. Sometimes I fantisize about going back to a system where you actually paid the doctors that treated you yourself, which could be a move, at least for smaller things, that put a lot more humanity back into the medical system. Sigh. Here’s hoping you won’t need to go back there for a long while.

  4. 4 Michele J
    March 9, 2011 at 9:11 am

    Awful. Can I ask if you have private or public insurance? Because this sounds like typical private insurance bloat and Aktionismus. Throw in a colonoscopy too, yeah!

  5. March 9, 2011 at 10:26 am

    “I’ve paid medical bills that weren’t owed just to get the system off our backs, too.”

    I did this several times in the US. Thankfully I haven’t had to do it here.

    The system here is still relatively so much better than it is there. Just today a friend said she had to pay over $200 for a test that costs 30 EUR here. I guess it’s all relative but I will miss the German healthcare system big-time if we ever end up back in the States. I feel they kept me in the hospital too long here, but I preferred the cautious approach to the approach in the US where they turn you out in the street one hour after the anesthesia wears off, and good luck figuring out if any of the things you go through thereafter are something you need to call the doctor for.

  6. March 9, 2011 at 10:47 am

    I’m with CN. I suspect that all this caution would have nearly bankrupted you under a US-style system.

    As a (part) Australian speaking to a Canadian, we can only wonder why governments around the world don’t follow our respective countries. Yes, both systems have problems. But an integrated single-payer system, with (sometimes annoying) scrutiny for over-service, is the best, most efficient, most humane solution.

  7. 7 G
    March 9, 2011 at 1:31 pm

    We are on private here and just did our colonoscopies as outpatients- you could have as well. In fact, the German, in an access of Teutonic cheapness, I assume, did so without anesthesia (he won’t do that again). Any time I don’t spend in a German hospital is a good one.My last experience was great for the operation, terrible for the stay.

    • March 9, 2011 at 4:14 pm

      I don’t think they’d even allow me on a private plan, and if they did, they’d charge a fortune. It’s because ever since they first measured them in Germany about 12 years ago, I’ve showed high blood enzyme levels. Don’t have hepatitis, never had, I’ve got a specialist’s stamp of approval saying it’s not from drinking too much, and I’m fit, right? But because I don’t fit into the norms, I’m seen as unhealthy. Oh, way high on the bad cholesterol, too, though I eat lean meat and skim milk, rarely eggs, etc. etc.

      But as some have said, maybe I should count my blessings I’m not in the States. It does sound worse there.

  8. 9 Jul
    March 9, 2011 at 5:11 pm

    Yikes, having to hang out in a hospital for several days waiting for them to do something that could have been out-patient sounds horrid. I suddenly have the urge to take extremely good care of my health. Right now.

  9. 10 G
    March 9, 2011 at 5:43 pm

    Our private is expat- when we change over, we will go public. I can’t imagine why (well, I can, but not ever in our family circs) see why we would want to be private. Much easier to do add on to the public. I think public in Germany is great, btw, compared to the US general. The rule is, if one is rich, US medicine is the best, otherwise, much better here (or in Canada).

  10. March 10, 2011 at 10:31 pm

    Wow. I don’t know whether I’m surprised or not. I always knew the whole sick system here was a money-making racket with health low among the priorities, but still, this is just madness.

  11. March 11, 2011 at 8:15 am

    There’s no way you’d spend that amount of time in a hospital bed in Australia if you weren’t actually acutely ill. We have a great health care system here but the hospitals do need more beds and social workers are under pressure to get patients out as soon as possibly after a procedure.

  12. 13 Michele J
    March 21, 2011 at 3:45 pm

    Was just thinking about this again today. A couple of other beefs I have with the German system: widespread prescription and use of homeopathic meds, multiple-week health resort stays (Kuren) and, although I know this won’t win me any friends, acupuncture.

  13. 14 G
    March 21, 2011 at 7:05 pm

    Wasn’t homeopathy just removed from the public insurance? I know my private doesn’t cover any. US insurance covers acupuncture, btw, and it has indicated uses (as I have read, though I don’t use it). Kurs are on the firing line: although I know one person who was prescribed one, I am told that it is harder to get one now then it used to be and there is a lot of discussion on their continuing to be paid.

  14. 15 annonamoose
    March 28, 2011 at 12:23 pm

    I was just in the hospital for almost a week last month (L&D). After attending every prenatal activity the hospital offers, I found out AFTER they induced me that the rate for a family room had doubled since they last quoted us the prices. Still worth every penny, quite honestly. We got the bill less than a week after we got home and they had tacked on mehrwertsteuer as well. My (German) husband wrote back giving them whatfor (you are required to provide end-user prices and we had everything they signed – I think the word ordnungswidrigkeit woke them up) and requesting a new bill. The acknowleged their mistake and knocked off a little bit for our trouble.
    RE: neverending hospital stays. Dh’s boss went in for a skin biopsy last summer and was out of work for nearly 3 weeks, most of which he spent in a mehr (and I mean mehr – 6!!!) bettzimmer.

    • March 28, 2011 at 5:43 pm

      It’s like a racket. There’s very little oversight, very few people on the public plans ever see how much their treatment costs, whether their plans were billed for work not done, and so on. At least with the private insurers, you can see it itemized.

  15. 17 Gordon
    May 17, 2011 at 2:47 am

    Sounds like the system there suffers from bureaucratising fasciitis (sp?)! 6 days to have tonsils removed!?!? I had mine out in ’62, I think it was, and THAT was just THREE days. A colonoscopy should be an out-patient prosedure, shouldn’t it? We have some problems here, too. I was sent for x-rays and was told the doc would have them in 2 days. When I told them he wanted me to take them back to him from the lab, they were on a disc and available in less than 10 minutes.

    • May 17, 2011 at 12:44 pm

      It’s very bureaucratic here, Gord. Once every quarter you also have to pay a €10 user fee for the first visit. The doctors hate it too, because it costs them more money to process than it’s even worth. We’re also going to start getting hosed pretty soon with new fees – up to €70 per month on top of our regular fees because they just can’t keep them under control.

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