Germans make most of a good deal

'Generally speaking, people are happy and I am happy." Doris OberlΣnder is retired and looks after her brother Jurgen.

'Generally speaking, people are happy and I am happy." Doris OberlΣnder is retired and looks after her brother Jurgen.

She is typical of many Germans, who recognise that they have a very fine health system, whatever their quibbles with aspects of it.

She remembers, and it was not all that long ago, when you could go to a spa for a nice long rest and have it paid for by a health insurer. Many healthy Germans saw the trip to the spa as a way of getting something back for their insurance premiums.

Today, people make a small contribution towards the cost of drugs and insurance companies place some financial limits on the amount a doctor can prescribe in a year.

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But patients and their health professionals have worked out ways of getting around the restrictions.

One Berliner told The Irish Times of going to an ear, nose and throat specialist last December, a time of year when doctors come close to the limits on their budgets, if they haven't already exceeded them.

The specialist had reached the amount the insurer would allow her to spend on the drugs she wanted to prescribe. But she knew a dentist who hadn't used up his budget and could provide the same drugs, so off went the patient. This, by the way, was not a hospital specialist. Most specialists in Germany work independently of hospitals, in much the same way as GPs work here.

OberlΣnder is another example of the way patients are willing and able to get around what they see as inequities. When she went to an orthopaedist who prescribed drugs and treatments that he said her insurer would not pay for, she went to her GP, who was suitably outraged to send her to another specialist, who gave her a prescription for the same drugs and treatments, all covered by her insurance.

None of this toing and froing cost her anything: the GP is covered by insurance as well. But she suspects some doctors are already rationing prescriptions in favour of older patients, giving younger patients drugs outside the insurance-covered list in order to keep money to treat older people.

Yet it's a simple matter to go to another doctor, who might have enough money in the budget to write prescriptions covered by insurance. There is no restriction on doctor-hopping, as it's called in Berlin, and patients carry a smart card containing all the necessary details.

But OberlΣnder recognises, as do many Germans, that insurers have to do something to limit their costs. "It's a good idea that a doctor has limits, and that certain medicaments have been taken off the list of things he can prescribe and that will be paid for by your insurers, like creams and certain tablets," she says.

Then she tells a story about an insurer's inflexibility that illustrates a good deal about the difference in expectations between Germany and the Republic. A friend's husband had Parkinson's disease and needed a special cushion. A specialist prescribed it but the insurance company had to approve it. Her friend asked if, to save time, she could pay for the cushion herself and get the money back after approval came through. The hard-hearted insurance company said no, she had to wait.

How long did it take for approval to come through, we ask, expecting to be told it took a month or six weeks, or never came at all. "One week," she says. Not bad for a hard-hearted insurance company.

The only area in which there appears to be a shortage of specialists is that of lung treatment. Once, OberlΣnder's brother was told he would have to wait three months to be seen. She asked if they could speed things up, and a lung specialist "fitted him in" after a month.

Other than that, there appear to be no waiting lists of any significance by the standards of the Republic, unless the patient insists on seeing a particular in-demand specialist and nobody else. But with lots of common-or-garden specialists around, in most cases there is no need for anyone to wait - and a new scheme now provides for home nursing, also covered by insurance.

Small wonder that, asked if there was anything she would like to see changed in the health system, she looks puzzled. "I never thought about this," she says. "I can't really say."

Her view is fairly widespread. As another Berliner put it: "I'm quite safe here in Germany with the health system. I know if I get an emergency, everything will be there for me."

The speaker is a nurse, Lisa Arnold, who works with patients admitted through the casualty department. She knows from experience that everything will run smoothly. She won't be spending days on a trolley or be subjected to the antics of drunks and drug addicts.

Things will be quiet and controlled. "That's Germany," she says. "Everything in order."