Information about the hospital system and about getting medical treatment in Germany.

Saturday, 30 December 2006

What are the prices for hospital treatment in Germany?

Since about 5 years, most hospitals in Germany are obliged to follow special government rules for the pricing of their services. A system called DRG (Diagnosis Related Groups) has been installed by law, and must be followed for all patients for whom the costs are covered by social security schemes.

DRGs work as follows: The relevant diagnosis, the medical procedures and any complicating factors that were encountered during the hospital treatment are entered into a special computer programm (called grouper). The system computes a certain relative weight from these factors. (This kind of system is most well known in Australia, from where Germany has adopted it.) So for example the replacement of an old hip endoprothesis without any complications might have a relative weight of 3.027. This factor is multiplied with the so-called base rate for the individual hospital, which is also fixed according to legally defined process and will be in a range between 2600.- and 3000.- Euro. So the DRG-treatment cost in this example would be between 7870.-Euro and 9081.- Euro.

For international patients, some hospitals adopt this system, others use a higher base rate. Some hospitals even abandon the DRG system and calculate their bills on a per day basis: The day can then cost 500.-Euro or more. This is not really within the legal framework, as there is a general rule that treatment prices must be equal for all patients, regardless of their status.

It is important to know, that the DRG price reflects only the hospital costs. If the patient opts to contract for personal treatment by the department chairman, a seperate bill for doctor's services will be added to the hospital bill. These doctor's costs can be between 50% and 100% of the hospital costs.

Further, international patients are usually offered to stay in single-bed rooms. For this add-on, another 40.- to 60.- Euro (or more) per day will be added to the bill. Normal accomodation will be the two-bed room in some hospitals, some hospitals still have 3 or more patients per room. Because international patients often have a different cultural background, accomodation in a single room is advisable. For example, patients from warmer climates (like Arabian countries or Nigeria) will allways find a room cold that is only heated to the normal German standard of 21 °C, and a compromise with a German co-patient will be difficcult.

In some cases, when certain doctors or hospital departments specialize in specific procedures (like artificial spinal disc implantation), they offer all-inclusive rates for these treatments. Of course, they can only do that if the diagnostic information that is made available by the patient prior to the appointment is reasonably complete and up-to-date.

All this makes the pricing situation for international patients rather confusing. It is thus advisable, to employ a patient referral organisation like German Hospital Service Ltd.. They will assist international patients to make the right options regarding treatment and accomodation standards, and they can countercheck the hospital's invoice to make sure it is according to the rules.

What are the Visa Requirements?

Unfortunately, Germany (with the other so-called Schengen countries) has adopted very strict regulations to reduce illegal immigration. Citizens of many foreign countries need a valid "Schengen Visa" in order to travel to Germany or any other Schengen country.

Basically, there are three types of visa: Tourist visa, business visa and visa for medical treatment. For the first two, travelers need an invitation from either a private person or a business company. Such invitations can only be obtained from special agencies in Germany, and the inviting person has to sign an obligation declaration, that he will cover any costs that might be caused during the stay in Germany.

For the medical visa, the requirements are usually the following (although you should ask your local German Embassy, what their specific requirements are):

  • An official letter from a doctor in the home country, confirming that the patient needs medical treatment abroad.
  • An official letter from the hospital in Germany, that the desired treatment will be offered to the applicant, together with a statement about the estimated costs and the duration of stay in Germany.
  • An official document to proove that the full amount of the estimated hospital costs has been paid to the hospital in advance.
  • Proof of sufficient funds for the costs of living during the stay in Germany.
In this way, the visa authorities want to ensure that no-one comes to Germany seeking hospital treatment but not having the funds to pay for the treatment. Because: If a patient presents himself at a hospital and is definitely in need of treatment, the hospital cannot refuse to treat him - even though the payment of the costs is not secured.

In order to obtain the two official letters from the hospital, it is very useful to employ a patient referral organization like German Hospital Service Ltd. They can help foreigners to find the right hospital (which can be trusted with an advance payment of many thousands of Euros), they can also make sure that the documents are sent to the patient by safe courier services; and they can help in the visa application process by contacting the embassy and providing additional information if necessary.

From all this, it is also clear: If a foreigner is seeking medical treatment in Germany, and he has ways and means to obtain a normal tourist or business visa to any one of the Schengen countries, this will be the preferable way to come to Germany. Once you are in the country, nobody looks at the visa status, and the hospital of your choice can be approached for treatment immediately. Furthermore, as for most medical procedures there are no waiting lists in German hospitals, you will be able to find a treatment possibilty right away - at least if you employ a referral organisation like German Hospital Service Ltd.

Friday, 29 December 2006

Can you have pregnancy interruption (abortion) in Germany?

Germany is not really the country of choice if you need an abortion. The procedure is closely regulated by criminal law, and many very good clinics, especially when they belong to church institutions, refuse "interruptio" altogether. Other countries in Europe are less strict about this issue.

However, most clinics do not decline treatment when it is necessary and the regulations have been followed. And of course, the medical procedure as such is not really the problem; it is standard in most obstetric clinics and the staff have a lot of experience.

One important point: According to German law interruptio can be legalized best within the first 12 weeks after conception. Time is the issue. So the doctor has to check first and make sure that the pregnancy is still in this early stadium.
what we need in Germany, is a consultation with an organization that specializes in trying to counsel women and offer advice about the possible alternatives to abortion and about the supportive services that exist for women in a critical pregnancy situation. Only after having gone through this consultation (where you have to explain your reasons), and getting a confirmation paper about the process, and after waiting another three days, the doctor is legally permitted to perform the operation.

If, in spite of this, a woman wants to come to Germany for this treatment, a patient referral organisation like German Hospital Service Ltd. should be employed in order to get the logistics arranged: In addition to the appointment with the hospital, an appointment with the consulting service must be made, and suitable hotel accomodation for the compulsory days of waiting before the operation must be booked.

This somewhat complicated procedure makes it difficult to get the treatment arranged for patients who need a medical service visa to come to Germany. Visa application can be too time consuming. The possibilty to get a tourist visa will be important.

A look at the financial side:

In principle, the operation can be done on an out-patient basis: You enter the hospital in the morning, have the operation, and leave the hospital in the afternoon. For this, the costs will be around 500.-Eur.

From a medical point of view that is not really advisable: It can happen easily that the patients do not feel too well for some days after the procedure. Then it is reassuring to be in or near the hospital. So, if you opt for in-patient treatment and stay in hospital for some days, approximately 500.- Euro per day hospital costs should be expected. As usual, the estimated sum has to be deposited at the hospital prior to admission. And if you opt for outpatient treatment, you should plan to stay at a nearby hotel for some days after the operation.

Hospital treatment in Germany

Hospital Treatment in Germany is an affordable, high quality alternative for patients who are looking for specific specialized medical help which is not available in their home country. There are over 2000 hospitals in Germany, offering all up-to-date treatments and procedures.
The quality of medical services is monitored by government institutions. The prices system is also defined by legislation, so pricing is reasonable - compared for example to US standards.
In order to find the most suitable hospital for a specific treatment, foreign patients should enlist the services of a patient referral company. German Hospital Service is such a company, offering assistance to English -and Russian-speaking customers.

Why are German Hospitals interested in international patients?

The point is, that German government has been trying to cut the annual budgets which hospitals get for the treatment of social security patients (90% of total hospital patients) over the past ten years. Essentially, the budgets were frozen, regardless of the annual rise in expenditure due to pay increases etc.
One of the very few ways for German hospitals to make a little extra income besides the government-regulated budget is the treatment of non-social security, independently paying patients from abroad. Some hospitals have put a great effort into trying to increase this venue of revenue, like forming little "private clinic" within the big hospital structure. They have built special luxury facilities with additional standards. Treatment in these private clinics is of course rather costly - but the luxurious standard makes it worthwhile for anyone who can afford it. Other hospitals offer the same medical standard, but only the normal accomodation standard (which is usually two patients per room, single rooms are available for a moderate surcharge). This is the choice for patients who are interested primarily in the medical expertise of the physicians who are going to treat them.
In addition, the treatment of international patients is also a source of additional revenue to the physicians themselves. At least in most cases they have contracts that allow them the treatment of "private patiente" as private practicioners.

What types of hospitals are there in Germany?

In order to decide which clinic you want to trust, you should be aware of the different types of hospitals that can be found in Germany, it is important to know the structural background:

Most of the acute care hospitals are "public institutions", that means they are run by government authorities - though at different levels: An individual town, bigger or smaller, can be the owner/sponsor of a local hospital or two, or the county. The federal states run only very few of the hospitals - but the really big and qualified ones: The universities, with their medical faculties are generally state responsibilty. Then there is a big number of non-profit organisations, like Red Cross, churches of the major confessions with their different entities, religious orders like the "Order of St. John". Currently, the smallest number of hospitals is under private , for-profit, ownership. A number of "hospital chains" like "Rhoen-Kliniken", "Helios-Kliniken" or "Asklepios-Kliniken" is very active on the hospital market, buying hospitals that are unprofitable for the government sponsors or taking charge via management contracts.
These differences by sponsorship do not necessarily coincide with different levels of medical expertise. The medical and care responsibilty of any individual hospital is usually defined by the federal state. A "hospital plan" fixes the number and medical mission of the clinical departments of each hospital. In this system, a primary care hospital will have local responsibility (usually 2 - 5 departments), secondary level hospitals will have central regional responsibilty (6 - 15 or more departments) and maximum care responsibility (with a full spectrum of medical disciplines). The hospitals of the universities are also usually on this tertiary level.
In general, of course, the chairman of a department at a higher level of medical responsibilty has a more profitable, i.e. more attractive and more competitive position. Thus the qualification and expertise that can be expected at this level will be better. But there is no rule at all stopping a smaller hospital from hiring a highly qualified specialist and making his department a center of medical excellence in a certain field. Actually this a strategy favoured by many hospital managers in order to attract additional patients and improve the economic situation of the hospital.
On the other hand, the medical professor and chairman of a big university department , while undoubtedly being highly qualified, has so many additional duties in the university, from administrative work to teaching students, that he is frequently forced to leave most of the medical treatment activities to his "Oberärzte", senior consultants within his clinic. So the"big name" alone will not guarantee the best-possible treatment - especially in surgical disciplines, where daily practice in the operating theatre is perhaps of paramount importance for the best outcomes - more than scientific reputation based on the number of published scientific papers.

All this goes to say, that is is not easy to find the best clinic, the best physician, for any given medical problem. Insider knowledge is essential. Which is the business of patient referral companies like German-Hospital-Service Ltd.