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I know it’s OT but would love to understand more about the health insurance situation in Germany and what’s happened in the last 20 years. Ideally in English wh

I know it’s OT but would love to understand more about the health insurance situation in Germany and what’s happened in the last 20 years. Ideally in English which is a big ask I guess. Moved to Germany in 2011 and still can’t work out the whole insurance thing (and don’t understand German enough to read and figure those nuances)

funcDropShadow 7y ago
To make it short, 20 years ago most hospitals were privatized, before they were run by universities, cities, and states and some other public actors. There were already some private hospitals, but not too much. Since, then most hospitals were sold to companies or in the better case transformed into companies, partly owned by their previous owner. Companies optimize for revenue, so they don't spend money on stocks of masks or reserve capacities that are only needed once in a lifetime. Nevertheless, there are significantly more ICU beds per capita in Germany than in most other european or western countries. The insurance system is split in two almost separate systems. One for everybody, the public health insurance system, where you can choose and switch between a range of public insurers. You must have health insurance in Germany. E.g. you cannot spend a semester as an exchange student without health insurance. If you earn above a certain amount per year, you are assumed to be able to provide for your own health insurance. You can opt-out of public health insurance and get a private one. They are very competitevly priced for young and healthy individuals. And they usually have way wider coverage. But you cannot go back after a certain age. So it is a risk, and there have been insurers that raised the cost of private insurance for elderly people by multiple hundred percents. On the other hand, the cost of public health insurances depends on your income and not on your health. If you are unemployed and you show that you try to get a job, your public health insurance is free as well. And children are free, if both their parents are in public health insurance. Then, there are private insurance policies that add on top of public health insurance coverage. Most people are in the public health insurance system in Germany.
- lnsru 7y ago
  I have public health insurance, but if you need some better treatment you can always pay for it by yourself. Some minor surgery for 300€ isn’t big deal. Or one can get additional insurance packages to mandatory insurance for all the special needs. My all older colleagues tell me, that private insurance is kind of scam. You pay almost nothing when you are young, but with age it costs more and more. You pay for kids on top and barely get better treatment than regular insured.
  - maigret 7y ago
    An insurance lawyer (friend of mine) also advised me to stay on a public plan and add up private addons where needed - those can be canceled very easily. I’ve not regretted that decision since.
    - gingerlime 7y ago
      I’d love to talk to you or your friend if you don’t mind. My contact details are on my HN profile.
  - gingerlime 7y ago
    Probably not better treatment but my private insurance almost always gets me faster appointments. I just mention the magic word and suddenly there’s an available slot next week (otherwise only in a few months). Happened more than once. My insurance broker said that the price I pay now should cover future payments and increases are only allowed if there are some overall increases to the treatment options. ie new more expensive treatments become available... so cost can increase but within certain boundaries. Was I misguided on that one?
- photonios 7y ago
  I think the Dutch system gives you the best of both worlds. Everyone is required to have at least basic health insurance. Every year, there's a new definition of what "basic insurance" entails and all insurance providers are required provide a "basic insurance" package at a specific cost. Of course, there are all sorts of addons to increase your coverage. If you are unemployed or earn below a certain treshold, you get a monthly stipend to pay for basic insurance. In the end, I can choose where to get my insurance from, but "basic insurance" is the same price everywhere and if I lose my job or I have very little income, I am guarenteed to get that stipend to help pay for it. Basic insurance is roughly ~100 euros/month.
hef19898 7y ago
As others stated, you have the public and the private system. The latter is accessible after you earn above a certain threshold for a certain number of years (no idea about the specifics as I would have been eligible but never bothered to change). You also have niche solutions for certain free professionals (doctors, artists,...). I would call the system pretty robust, as you cannot be uninsured. From personal experience: Having my kids insured under my name, under my wife's name when I earned less than her, being insured under my wife during a certain time of a sabbatical, insured through unemployment and now as an entrepreneur I never changed insurance provider. Only the status changed. Interesting detail, even the public health insurance sector is run by commercial insurance companies. The minimum plans are defined by the state. Regardless of how many people are insured under your name, premiums don't change and stay at a certain percentage of your salary. Again, slight differences between providers but usually around 15 or so percent. Currently I pay much less, as there is no revenue yet. Also nice, premiums don't change with previous sickness and preexisting conditions. Also 6 weeks of paid sick leave per sickness, resets for each sickness after a certain number of months (again, don't ask the exact number). One important insurance to add is continued salary after the six weeks are over. Costs close to nothing when done early and can save you. Non serious things tend to be over well within 6 weeks. But serious ones can take considerably longer. And the last thing you want is money problems the. I spend 6 months on sick leave once, didn't have to worry about my job nor money. Was a nice thing.

funcDropShadow 7y ago

To make it short, 20 years ago most hospitals were privatized, before they were run by universities, cities, and states and some other public actors. There were already some private hospitals, but not too much. Since, then most hospitals were sold to companies or in the better case transformed into companies, partly owned by their previous owner. Companies optimize for revenue, so they don't spend money on stocks of masks or reserve capacities that are only needed once in a lifetime. Nevertheless, there are significantly more ICU beds per capita in Germany than in most other european or western countries. The insurance system is split in two almost separate systems. One for everybody, the public health insurance system, where you can choose and switch between a range of public insurers. You must have health insurance in Germany. E.g. you cannot spend a semester as an exchange student without health insurance. If you earn above a certain amount per year, you are assumed to be able to provide for your own health insurance. You can opt-out of public health insurance and get a private one. They are very competitevly priced for young and healthy individuals. And they usually have way wider coverage. But you cannot go back after a certain age. So it is a risk, and there have been insurers that raised the cost of private insurance for elderly people by multiple hundred percents. On the other hand, the cost of public health insurances depends on your income and not on your health. If you are unemployed and you show that you try to get a job, your public health insurance is free as well. And children are free, if both their parents are in public health insurance. Then, there are private insurance policies that add on top of public health insurance coverage. Most people are in the public health insurance system in Germany.

lnsru 7y ago
I have public health insurance, but if you need some better treatment you can always pay for it by yourself. Some minor surgery for 300€ isn’t big deal. Or one can get additional insurance packages to mandatory insurance for all the special needs. My all older colleagues tell me, that private insurance is kind of scam. You pay almost nothing when you are young, but with age it costs more and more. You pay for kids on top and barely get better treatment than regular insured.
- maigret 7y ago
  An insurance lawyer (friend of mine) also advised me to stay on a public plan and add up private addons where needed - those can be canceled very easily. I’ve not regretted that decision since.
  - gingerlime 7y ago
    I’d love to talk to you or your friend if you don’t mind. My contact details are on my HN profile.
- gingerlime 7y ago
  Probably not better treatment but my private insurance almost always gets me faster appointments. I just mention the magic word and suddenly there’s an available slot next week (otherwise only in a few months). Happened more than once. My insurance broker said that the price I pay now should cover future payments and increases are only allowed if there are some overall increases to the treatment options. ie new more expensive treatments become available... so cost can increase but within certain boundaries. Was I misguided on that one?
photonios 7y ago
I think the Dutch system gives you the best of both worlds. Everyone is required to have at least basic health insurance. Every year, there's a new definition of what "basic insurance" entails and all insurance providers are required provide a "basic insurance" package at a specific cost. Of course, there are all sorts of addons to increase your coverage. If you are unemployed or earn below a certain treshold, you get a monthly stipend to pay for basic insurance. In the end, I can choose where to get my insurance from, but "basic insurance" is the same price everywhere and if I lose my job or I have very little income, I am guarenteed to get that stipend to help pay for it. Basic insurance is roughly ~100 euros/month.

hef19898 7y ago

As others stated, you have the public and the private system. The latter is accessible after you earn above a certain threshold for a certain number of years (no idea about the specifics as I would have been eligible but never bothered to change). You also have niche solutions for certain free professionals (doctors, artists,...). I would call the system pretty robust, as you cannot be uninsured. From personal experience: Having my kids insured under my name, under my wife's name when I earned less than her, being insured under my wife during a certain time of a sabbatical, insured through unemployment and now as an entrepreneur I never changed insurance provider. Only the status changed. Interesting detail, even the public health insurance sector is run by commercial insurance companies. The minimum plans are defined by the state. Regardless of how many people are insured under your name, premiums don't change and stay at a certain percentage of your salary. Again, slight differences between providers but usually around 15 or so percent. Currently I pay much less, as there is no revenue yet. Also nice, premiums don't change with previous sickness and preexisting conditions. Also 6 weeks of paid sick leave per sickness, resets for each sickness after a certain number of months (again, don't ask the exact number). One important insurance to add is continued salary after the six weeks are over. Costs close to nothing when done early and can save you. Non serious things tend to be over well within 6 weeks. But serious ones can take considerably longer. And the last thing you want is money problems the. I spend 6 months on sick leave once, didn't have to worry about my job nor money. Was a nice thing.