
Difficulties accessing medical services as an EU immigrant in Germany - mindflayer
https://medium.com/@mindflayer/germany-has-a-bug-3c4ffb0509f5
======
deng
OK, first off: you definitely need some German speaking friend to deal with
German bureaucracy. So ask around who can help you with going to the
"Behörden" to deal with the problems of your friend.

If the sickness of your friend is an emergency, your doctors should accept the
European card EHIC (if she does not have one, she should be able to get it
from her Italian insurance). But this of course is not a permanent solution,
so yes, your friend needs a German insurance. If this is not an emergency but
also not resolved quickly, then she should really think about returning to
Italy for treatment, as the costs can escalate pretty quickly; not only
doctors but especially pharmaceutical drugs can be very expensive in Germany.

If your friend wants to live in Germany, then yes: she needs to go to the
"Einwohnermeldeamt" an register there. I know that this does feel weird for
people who are not used to this, but it's usually a pretty easy process and
done quickly. The only thing you need for this is a permanent residence in
Germany, so some kind written of rental agreement ("Mietvertrag") is
necessary. As for private/public insurance: avoid the private ones if
possible. However, if she was privately insured in Italy, she definitely
cannot enter the public one in Germany, so private is the only option then. If
she has Italian public insurance: To enter German public insurance, you do
_not_ need to have a job, but you need to actively _search_ for one. So she
will have to go to the "Arbeitsagentur" and register there as searching for a
job. She'll _definitely_ need some German speaking fellow to help her with
this, otherwise it will take far longer. I think it is also possible to remain
in Italian public insurance and "enhance" the EHIC support so that it covers
Germany, so you should investigate in that direction as well. Good luck and I
hope your friend will get better soon.

~~~
Haldir
The enhance part is probably mobile Form S1.

[http://europa.eu/youreurope/citizens/work/social-security-
fo...](http://europa.eu/youreurope/citizens/work/social-security-
forms/index_en.htm)

~~~
deng
Yep, that looks like what I had in mind. If as an EU citizen you work abroad
in the EU, then really: you absolute need to get an EHIC as a minimum, so that
at least emergencies are covered (I guess sometimes local doctors won't accept
this since they are afraid to not get their money; in that case, go to an ER
in a hospital).

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yummyfajitas
I would also like to move to another country where I've contributed nothing,
and then have taxpayers in that country give me free stuff. Maybe next time I
need medical work done I can stop in the Italy, have the Italian taxpayer pay
for it, then fly off to a country where I'd actually like to live (e.g. a
country which cares more about consumers than the taxi mafia).

In all seriousness, the Indian medical system is a shining example of how to
be functional. You show up, find out what needs to be done, ask the price, pay
and it gets done. I've had LASIK and 2 spine surgeries done in India, +1 will
return for all my future medical needs.

~~~
deng
> In all seriousness, the Indian medical system is a shining example of how to
> be functional. You show up, find out what needs to be done, ask the price,
> pay and it gets done. I've had LASIK and 2 spine surgeries done in India, +1
> will return for all my future medical needs.

In Germany (and I guess pretty much any country) this is possible as well. You
simply say you are a "Selbstzahler", and I assure you doctors in Germany will
be thrilled to treat you (with an advance payment, of course).

I guess what you're meaning is that the Indian medical system is far _cheaper_
, but that's another discussion...

~~~
yummyfajitas
I've only spent about 6 hours in Germany, so I can't speak about Germany. But
in many places - the US and UK, for example - it's often quite difficult to
get medical work done simply by paying money.

For example, in the US many doctors refused to treat me - I was later told by
a doctor that this is for regulatory reasons. US hospitals are famous for not
providing a price before treatment, and often trying to sneak non-insured
items onto the bill. Compare the expereinces here
([https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-
sur...](https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-
medical-bills.html) ) with mine
([https://www.chrisstucchio.com/blog/2015/medical_tourism.html](https://www.chrisstucchio.com/blog/2015/medical_tourism.html)
).

I've had similar difficulties in the UK - it's mostly NHS or get out of town.
(My issues in the UK were minor, so I decided to just wait until I reached
India to get them fixed.)

~~~
deng
Interesting. I didn't think it was a problem to be treated when you put cash
on the table. But maybe you have to be _very_ rich. At least in Germany, some
hospitals/doctors in Munich are pretty known for courting rich patients from
the middle east, and those surely don't depend on some insurance...

~~~
yummyfajitas
Medicine is always wonderful if you are a petro-monarchy prince. I'm just a
regular guy.

Anecdotally, I've been told that a lot of middle Eastern medicine is corrupt
and low quality. I ran into a lot of gulf state medical tourists in India who
told me this (obviously a biased sample).

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devnonymous
While I could possibly sympathize a bit with the parts of the post dealing the
frustration of dealing with German bureaucracy, after having experienced the
Italian health care (having experienced both personally), I don't understand
the sense of privelage.

As a non-eu immigrant in Germany things are far worse and IMHO one just trades
health care issues for other issues if one were to move the other way (Germany
to Italy)... Or for that matter anywhere else in the world.

Seems like the apt scenario for the quote "When in Rome..."

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tomhoward
The issue of how to fund welfare services, particularly health care, is
basically the most difficult challenge faced by every government.

Health care budgets in most major countries seem to be growing faster than
their ability to pay for them.

Naturally, every citizen and every immigrant feels like they should be able
access whatever health care they need whenever they need it, particularly in
an emergency.

And the notion that critical health care is a fundamental human right that
should be provided to everyone is a reasonable one.

But it still doesn't address the question of how governments pay for all the
staff and facilities and supplies that it takes to run a health system,
particularly when so many western countries - Germany more so than any other -
have just had a huge influx of people who need access to welfare services but
aren't paying taxes to help fund it.

I don't have answers, I just know it's a hard problem and it's only getting
harder.

But here's a suggestion: I think the post would be stronger if you were able
to consider things from the point of view of the government who is faced with
the challenge of providing and funding their health system, and of setting the
right incentives for people to contribute their fair share of the costs and
only use the services they really need.

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tty74
I would really like to know what the exact problem is: I have been "freiwillig
versichert" for years as a freelancer, no need to have an official employment.

~~~
tty74
I see, apparently this is not available for EU foreigners. This is indeed a
big problem!

------
cleansy
I sort of agree with some of the commenters here - the system works as
intended. If you move to any country without a job first you will have a hard
time. Health insurance shouldn't be part of a free 'welcome package' to
whoever just feels like dropping by.

However, I think it would be hugely beneficial when all (goverment sanctioned)
EU health insurances would be valid in all EU countries. If you get a private
insurance in Germany you usually have this already covered. But not with the
state insurances, for whatever reason.

~~~
bjornsing
> If you move to any country without a job first you will have a hard time.
> Health insurance shouldn't be part of a free 'welcome package' to whoever
> just feels like dropping by.

I can understand this reasoning in the general case, but I'm not sure I agree
when the two countries are Italy and Germany. Both Italy and Germany are part
of the European Union, and one of the chief political ambitions of this union
is the free movement of people within the union. To me it feels a bit weird to
say this ambition applies only to the healthy and highly productive. I can
certainly see how this can be perceived as a form of "second class
citizenship".

But yea, I guess your stance here depends a lot on your politics. Personally I
have no problem with people coming to Sweden and using the generous government
funded health care system, but I have been thinking about the reverse problem
a bit lately: If I as a Swedish citizen move abroad (even outside the EU) I
have "free health insurance for life", in the sense that if I get seriously
ill I can always get on a plane back to Sweden and receive some of the highest
quality care on earth free of charge. I would not need to pay a dime in taxes
for this. At this moment we've extended this free insurance to about 660 000
people (the equivalent of 1/15 of the Swedish population), and I bet that's
mostly people who are relatively very well off.

I guess when you mix peoples freedom of movement with money it gets
complicated real fast...

------
henningpeters
Having lived abroad for some time I can sympathize with the problems
mindflayer and his girlfriend have. Health insurance is often a pain as a
foreigner and immigrant, Germany doesn't seem to be an exception.

I looked a bit around and it seems that the OP didn't research all options
(language barrier and bureaucracy is often a problem here).

@Mindflayer: I suggest you find an expert that can guide you through this
jungle.

But what I found in my quick research is that there is a european health
insurance card (apparently one can get it from one's EU health insurance in
one's home country, it's called EHIC). It allows a German doctor to book
services against your Italian health insurance. Unfortunately, it only covers
emergencies.

For other medical services you are right, it's probably easiest if you have a
job or are married. But it seems that there is another option: your girlfriend
registers as unemployed/job seeking. Job seekers from EU countries are treated
similarly as employees and hence are entitled to public health insurance.

Source: [https://www.krankenkassen.de/meine-
krankenkasse/krankenversi...](https://www.krankenkassen.de/meine-
krankenkasse/krankenversicherung-eu/arbeit-suchen/) (German)

------
mindflayer
Most of the comments are definitely out of topics. The European health
insurance card only covers emergencies, and I've never said it was a problem.
The problem was being able to investigate the problem because they only
allowed her to access to some basic checkups like blood exams, that were not
enough to solve her problem. Of course we have German speakers as friends but
in this case it did not help. The biggest problem I see is the fact that
Anmeldung and the health insurance subscription are totally disconnected, so
you can have people with the right to live in Germany but actually without the
possibility to access to the German healthcare system, that is again what I
call a bug.

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DasIch
She's not registered, she doesn't have a job and never had one. In other words
she's a tourist and is treated as such.

That's not a bug, that's a feature and the system working exactly as designed.

~~~
mindflayer
It seems you totally invent a story. I'm complaining about the fact that you
can register in Germany without having access to an health insurance, and
that's bad from any point of view.

~~~
DasIch
Registering and having health insurance are completely unrelated to each
other. Additionally registering in Germany is actually a legal requirement,
having health insurance is not (under certain circumstances).

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daseong
Not a direct response to the post. But if you have someone visiting you from
another country, consider setting up an "incoming health insurance" for them.
It's just a few bucks.

Whenever I have relatives coming to Germany from abroad, I will have this
insurance ready for them.

~~~
mindflayer
Again, she is registered in Germany and she has everything she needs except
for the most important thing, which is the possibility to access to the health
system.

------
osullivj
Gotta follow the rules in Deutschland! Not so in Italy...

~~~
mindflayer
I feel like you did not get the point. I'm criticizing exactly this rule which
does not make any sense, imho. I am not comparing the two countries.

~~~
guitarbill
Doesn't matter if the rules don't make sense, they still have to be followed.
Franz Kafka even wrote a book or two about this.

~~~
mindflayer
Again, you definitely missed the point. I've never said I don't want to follow
the rules.

------
heisenbit
There are some details missing. I suspect that the woman moving to Germany
effectively moved her out of the Italian health system. Different story if she
was traveling to Germany - her Italian health insurance should have been
portable then. Moving residence between countries without researching health
insurance is not wise. German hospitals will still provide emergency care if
needed in a life threatening emergency.

Yes, the German system is not so open. The author correctly describes two
options semi-public/private both with entrance hurdles.

The private system are individual insurances. There may be deductibles but
generally their coverage is very good. Doctors are paid often double the
amount they get from public patients so are also very eager to get these
patients. Your health risk here is over-treatment. Why is not everyone getting
this fantastic deal? One has to earn a certain amount, be self employed or be
a public servant with tenure. The cost depends on pre-existing conditions so
unless you enter as healthy&young it becomes very expensive option.

The semi-public insurances are administered by a couple of companies all
following the 98% the same rules, some dread disease pool payments between
them forced by government to allow portability. Doctors are paid less but the
majority of the patients are in this system so there are still penty. Getting
a specialist is another topic - there are usually waiting times. The semi-
public insurances compete on the 2% differentiation, marketing and their
service. One typically enters the public system by _not_ having a private
insurance and getting a low paid job. There are other routes to entry but any
path less trodden is harder to walk. Unlike the private system the public
system covers family (partner if not working and dependent children up to a
certain age). Payment depends on your salary up to a limit. In 2017 the
MAXIMUM cost based on a rate of 15.7% of ones salary up to a max. salary of
4350€/month are: 317.5 employee and 317.5 employer = 635€/month. If you are
earning half then it will be only half.

For anyone in the private insurance the path back to the public insurance is
explicitly closed at a certain age. The German system differs from the US
system in particular as there is no Medicare. Financing health care in
retirement can be a problem for people as the cost in the private system goes
up. The private insurances have to put money aside to compensate for health
costs of their older customers but that only cushions it.

Health care is expensive and needs financing for dread diseases and high age.
This hard fact is a limiting what is possible and requires boundaries to
entry. One can not have people saving in one system for a long time and
letting others into the same pool when they need access to that pile of money.
Germany is able to sustain two systems due to the boundaries between them. The
dual system was becoming unstable a few years back when the birth rate decline
lead to more older people leaving the private system when older and going into
the public one. They enjoyed better service and lower rate in the private
system when their health became more costly relied to the wider population in
the public system driving up costs there. That was seen as unfair and lead to
a shoring up of the boundaries between the two systems.

~~~
mindflayer
Italian health insurance works only for emergency, that does not mean
everything else is not important. Every syndrome is treated as not urgent,
meaning your life is not in danger.

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SebiH
Article aside - repeating (what feels like) every other sentence as big
heading is incredibly annoying and makes it hard to focus on the content. Who
thought that would be a good idea??

~~~
mindflayer
It's a layout aspect and there's nothing wrong with it. If you like pure text
articles you can just use an app like Pocket that extracts only the text from
every article you add.

