What nobody tells you

The German Healthcare System

It’s good that we have a healthcare system – no question about that. But sometimes I wonder if this system is truly fair. Or is it ultimately just about making a profit?

I believe there are many people who wish for a fair healthcare system. People who stand up for one another and fight for more justice in how health is handled.

But what can these people actually achieve?

As someone with a chronic illness, you get to know the healthcare system in all its facets – the good, but also the challenging sides. Here, I’m sharing some experiences I wish I had made earlier. Or even better: things I wish the healthcare system itself had informed me about in time.

If you’re interested in a specific topic, feel free to reach out!

For my international readers: I am curios about your healthcare system. How are you coping?

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Physiotherapy

Typically, physiotherapy prescriptions are issued for 6 or at most 10 sessions. Each doctor has a specific budget per quarter for their patients that they must manage. But what happens if you have a chronic illness and rely on regular physiotherapy? What health insurance companies rarely reveal is that there is a long-term prescription option for therapeutic services. Here is an excerpt from the website of the National Association of Statutory Health Insurance Physicians: Diagnosis list remedies - Long-term need for remedies The Joint Federal Committee defines in a diagnosis list which conditions are considered to require long-term therapeutic services. For these diagnoses, no application or approval process with the health insurance is necessary. If the condition is not listed, the patient can submit an individual application to their health insurance company. For approval, it is crucial that the severe, permanent functional and/or structural impairments are comparable to those on the diagnosis list. Prescriptions under the long-term therapeutic need are not subject to economic efficiency reviews. Special regulatory requirements In a separate diagnosis list, the National Association of Statutory Health Insurance Physicians (KBV) and the Association of Statutory Health Insurance Physicians (GKV-Spitzenverband) agree on which conditions often require more therapeutic services, thus having a ‘special prescription need’. The costs for these prescriptions are excluded from economic efficiency reviews within the doctor’s prescription volume. This means: Prescriptions can be issued for up to 24 sessions. These prescriptions do not count against the doctor’s budget but are covered by the health insurance companies. However, the system behind it is much more complex. There is an annual diagnosis list, and there is a difference between long-term therapeutic need and special therapeutic need. If you want to learn more about this and find out what you can do to get such a prescription regularly, feel free to contact me. Source (20.08.2024): https://www.kbv.de/html/heilmittel.php

Patient forums

Nowadays, navigating the healthcare system is a major challenge. Medical staff or health insurance employees are not always helpful. I have often experienced that health insurers did not tell me the truth about my legal entitlements. Even when I referred to the law and the relevant sections, they remained stubborn. It’s really unacceptable. However, I have found a lot of support, advice, and simply understanding in various patient forums. Whether you have a diagnosis or a suspicion, there are self-help groups, non-profit organizations, or patient forums. These are typically made up of patients like you and me. I must admit – I am still on Facebook because of the groups. It is there that I have found the most interaction with people who have similar diagnoses. Depending on the diagnosis, it is actually worth looking for answers in international groups as well. Of course, it’s no substitute for a doctor’s visit, but this is where my initial research started. A friend once asked me, "Why are you doing the doctor’s job?" To which I can only reply: The better you understand your own situation, the more likely you are to find the right path for yourself. If you have questions about organizations, groups, or forums, feel free to contact me.

Doctor’s letters

Medical Reports: Incomplete, Incorrect, or even 'Invisible' Medical reports are of great importance to patients. They are crucial both for ongoing treatment with other doctors and for obtaining support from health insurance companies and authorities, such as aids, disability certificates, care levels, or simply subsidies for travel costs. However, doctors are typically paid very little or not at all for writing these reports. Due to staff shortages, this issue is becoming increasingly complex. I have received countless medical reports filled with spelling mistakes and even incorrect medical statements. On one occasion, a report confused my symptoms of elevated intracranial pressure with those of low intracranial pressure—fatal. Generally, patients do not have the right to request changes to a medical report, but the issuer is obligated to provide accurate information. This is a frequent point of contention. Additionally, some (specialist) doctors, despite repeated requests, simply do not issue medical reports. I have even drafted medical reports myself—no joke. However, these were only drafts that I provided to the doctor. The doctor then had the opportunity to adjust and sign the draft. I found that this approach is faster and results in fewer errors in the medical reports. It’s not an ideal solution, but worth a try!