Health Care Hints

Tips for Expatriates

Health Care Hints

General information
Emergency care and help outside normal business hours
Making an appointment
Health insurance
In the hospital
Reproductive health
Pharmacies and prescription medication
General information

Make finding a primary physician one of your first priorities when you arrive in the city. If you make an appointment and meet your doctor for a routine check up before you get sick, things will be easier for you later. This is especially true if you have children.

Try to find a primary physician (Allgemeinefacharzt) and then ask him or her to recommend specialists as you need them. This will save you from picking names blindly from the phone book. Also, you will find that fields differ slightly from country to country. You might have a different idea to your doctor of what type of specialist you need to see.

If you want a doctor who speaks English, most embassies distribute lists of English-speaking doctors. But these lists are only meant to be a convenience. Embassies will not recommend individual doctors. The list at the US Embassy is compiled through a very informal word of mouth system. Sometimes doctors recommend each other, sometimes patients recommend doctors. But their health center keeps the info on file for all the doctors, and they say that if there were a reason a doctor shouldn't be on the list, they would know about it. I used to translate for the US Embassy's health unit in Bonn, so I am aware that they routinely depended on a number of different doctors. You should be aware, however, that many of the doctors embassies recommend are very well known in their field, which means they are unbelievably busy. You might have to wait a long time to see them. Or you might not be able to see the particular doctor on the list at all, although you will usually be able to see one of her partners.

If you take sick leave in Germany, you need a note from your doctor. This is another reason why it's a good idea to know your doctor ahead of time. But beware - many doctors will insist you take a whole week off when you only wanted to stay home a day or two. At least you can rest easy knowing that German companies give their employees unlimited sick days.

Emergency care and help outside normal business hours

In case of a medical emergency, call the fire department (Feuerwehr) at Tel: 112. Fire department vehicles function as ambulances in Germany, but they will take you only to the nearest hospital.

Private emergency services (Ärztlicher Notdienst) will send doctors and dentists to your home, 24 hours a day, seven days a week. Call 19 242. Doctors work with these services on a rotating basis, usually taking time off from their private practices to do so. Although you can't bet on getting a doctor who is fluent in English, you can expect an adept professional. These services are covered by public and private insurance.

I had a terrible kidney infection when I first arrived and was treated by a wonderful doctor. Since I didn't have insurance yet he kept the price for treatment extremely low and gave me my medicine for free. This is an exception to the rule though. I think he felt sorry for me because I was so sick and didn't know what to do (my friend forced me to go because it had gotten so bad that I could barely walk). Although I visited him in an office it turns out that it wasn't his office and I was never able to track him down to thank him. The story has two points. One: if you like the doctor they send you, make sure you take his or her name and phone number so you can find her again. Two: doctors from every field work for emergency services. Make sure you specify if you want to see a certain type of specialist.
If you need a doctor, a dentist, or a pharmacist on a Sunday several private companies offer transportation to the hospital in cases where it isn't an emergency, but you can't get to the hospital yourself. Look up "Krankentransport" in the phone book.

Making an appointment

Some doctors ask their patients to make appointments, some will tell you to come in any time. Either way, an appointment doesn't necessarily mean you will see the doctor at the time you scheduled. Ask the receptionist what time of day you will have the least wait, and then be prepared to sit in the lobby for up to an hour or sometimes even more.

Some strangely ingrained custom dictates that everybody greets the other patients when they walk into a doctor's waiting room and says goodbye when they leave. Don't be alarmed if this happens to you. As soon as you get back on the street, you will be ignored again. :-)

Curtains in examination rooms, sheets, or gowns are not customary accessories for an examination in Germany. If you feel uncomfortable, you can bring your own towel or sheet, although you might be rewarded with some quizzical looks. One ob/gyn I visited even requests that her patients to bring their own towel to sit on while in the chair. Doctors sometimes don't leave the room while you get undressed either. If you are having a pelvic exam with a male doctor, German law requires that a nurse be in the room at all times.

Health insurance

Almost everybody in Germany has health insurance. Ninety percent of the population subscribes to the public program (Krankenkasse), which is mandatory unless you are above a certain income bracket. The other 10 percent have private insurance.

If you've managed to wiggle your way into the country without health insurance, chances are you won't be able to stay that way for long. First of all, to get a visa or a residence permit, you have to be insured, and you have to have the documents to prove it. Most doctors will not be willing to see patients who don't have health insurance. If you have a foreign insurance, you will probably have to pay, in cash, at the end of your visit.

If you are staying here for a long period of time, you will certainly have to consider whether you want a public or private insurance, a German program or one from your home country. Although the overwhelming majority of German citizens have public insurance, many doctors prefer to see patients with private policies. Some of them even specify that they will only see patients with private policies. This is simply because they get paid more for it.

You might have trouble enrolling in a German university without German insurance, even if your insurance is valid abroad. In which case, the cheapest alternative is to get a public policy. Their student rates run to around DM 100 per month. I enrolled at the university and ended up paying more than a student but considerably less than a working person would have paid (since I was working and "taking classes").

UK citizens who pay for the British national health service can get medical and dental treatment in Germany for free, if you have an E111 form from a UK post office. This includes treatment in public hospitals (with doctor referral except in emergencies) minus a small daily charge, for up to 14 days. You will still have to pay for some prescription medicines.
Otherwise, you will probably be better off with a private insurance for people living abroad. They will cover some areas that are specific to the expatriate lifestyle, and are often cheaper than German packages.

If you are American, make sure that the insurance you have will cover you when you are outside the States. Most of them (including Medicare and Medicaid) don't, so you will probably have to get new coverage.
When you shop for an insurance company, check to see if you have to pay for your visit up front and then collect reimbursement, or if the company will accept receipts from your doctor. Many American companies will require that you translate into English all claims you send to them. If you don't know a translator who can do this, feel free to contact me. As I said before, I did it for the US Embassy Health Unit for 2 years before they moved to Berlin and offer quality translations at a very reasonable rate.

In the hospital

If you have an overnight or extended stay in the hospital, you might be assigned a new doctor. German doctors work in independent private practices. They don't have the same working relationship with medical campuses or hospitals that they do in Britain or the States. Some physicians have their own beds reserved in hospitals so they can see their patients there. But this is not always the case.

A "private" room in a hospital isn't necessarily a room you get to yourself. Hospitals have a certain amount of space allotted to patients with public insurance and for those with private insurance. "Private" means private insurance; these rooms are generally used for two patients who are separated by a curtain.

Many expatriate patients come out of a hospital stay saying their only complaint was the food. German hospital food might be quite different to what you expect - a hot meal at lunchtime and rye bread and some sausage in the evening. Some hospitals are updating their menus, but be prepared for those who haven't.

Bring towels and soap with you, as well as any personal hygiene products you will want. Sheets will be provided by the hospital.

Reproductive health

The "day-after pill" or RU487 is widely available in Germany, although some Catholic hospitals won't administer it. Go to the emergency room if you need to take it. Abortions are legal in Germany, although there is a law that you have to receive counseling beforehand.

Catholic and Protestant churches both used to offer their own free abortion counseling services. When the pope forbade the Catholic church to continue, the Protestant church had a field day advertising their comparative open mindedness.

There are also private counseling services available for free. Centers in the East are traditionally a bit more laid back about the procedure than in the West, but you should find helpful advice wherever you choose to go. Counselors will also be able to refer you to a doctor to have the operation.
Pregnancy tests (Schwangerschaftstest or B Test) are available in pharmacies (Apotheke), but you have to ask for them at the counter.

If you plan to have a baby in Germany, you will find a number of obstetricians and midwives to help you through the process.
To make sure that your doctor is there when you deliver, call for transportation as soon as you start feeling contractions. If you wait too long, transport services will only take you to the nearest hospital, for fear you will have the baby in the car.

Pharmacies and prescription medication

Pharmacies (Apotheke) are open 9am-6pm Monday to Friday and 9am-12pm Saturday. They all provide addresses for services outside of opening hours. At Pharmacies, you will be able to buy prescription medication and a few health care products. You'll be able to find most over-the-counter items and a wide range of other personal care products for a cheaper price at the larger chain drug stores like Schlecker or Drospa.

Prescription medication is sold in Germany by company name, not by the active ingredients in them (as they are in the States, for example). Usually doctors prescribe the most expensive one, so ask your doctor if there is a cheaper medicine available with the active ingredients you need.

Medication does not come with dosage instructions on the package. Make sure you ask your doctor when and how much you should take, and write down the information so you have it later. In the package, you will find a long-winded description of the medication. It's there to free the pharmaceutical companies from liability. Other than that, it has little practical use. You will find the medicine's active ingredient in small type somewhere on this sheet, though, if you want to know what you are taking.

Doctors give out two different types of prescriptions. For those of a pink slip of paper you have to pay a small supplementary fee, or "state fee," usually around DM 12 per package. If you have private insurance, you will most often get prescriptions on a blue sheet of paper, which means you have to pay the full price of the drug up front and then send the receipt to your insurance for reimbursement. This means you might have to pay up to DM 600 in cash because pharmacies don't accept credit cards.