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Seven of the biggest healthcare culture shocks in Germany

Scared of falling sick when living in Germany? Don’t be. The country’s healthcare system is among the world’s best – even if things can be a little different to what you’re used to. To lessen the shock, here’s The Local’s guide to the cultural quirks that might trip you up.

Published: 20 June 2019 05:00 CEST
Seven of the biggest healthcare culture shocks in Germany
Photo: Jesper Aggergaard on Unsplash

Dealing with the healthcare system in a foreign country can be one of the most daunting things about living abroad. When you’re ill, the last thing you want on your visit to the Hausarzt (GP) or the emergency room is to encounter unfamiliar medical conventions that might come as a shock when you’re feeling more than a little delicate already.

To help you brace yourself, we’ve teamed up with ottonova, a private health insurer offering special rates and English-language support to expats earning over €61,000 a year in Germany, to show you exactly what to expect when using the country’s healthcare system.

1. Getting naked is normal

Germany’s penchant for naked saunas and nudist sunbathing is well known, but it still comes as a shock to many foreigners that this Freikörperkultur (free body culture) also applies to healthcare. Doctors won’t bat an eyelid at asking you to strip off your underpants in front of them as they continue talking to you, or calling in a specialist to greet you as you sit there topless. And nurses will think nothing of sending you down a hospital corridor with your buttocks on show, or expecting you to relieve yourself in a bedpan in front of your hospital roomies. Try not to be embarrassed – because they certainly won’t be.  

Find out more about ottonova’s expat health insurance packages

2. Honesty is the best policy

Photo: Online Marketing / Unsplash

Got bronchitis? Why on earth didn’t you come to the doctor sooner?  Don’t do regular exercise or eat fruit every day? Tut, tut, tut. Of course, bedside manner varies from doctor to doctor, but most are uncompromisingly frank, and it’s not uncommon to find yourself being reprimanded if your behaviour isn’t up to scratch. Suck it up – in Germany, the Götter in Weiß (Gods dressed in white) know best.

3. Things don’t always happen quickly

While German healthcare is generally regarded as being of good quality, the system can be slow, particularly if you have public health insurance. Don’t be surprised if you have to wait weeks or more for an appointment with a Facharzt (specialist), especially in big cities. For some foreigners (looking at you, Brits), this might make you feel right at home, but for others used to more efficient service, it takes some mental adjustment.

Taking out private insurance will help you get seen more quickly. For example, with ottonova’s health insurance you can consult an English-speaking doctor via video call, often with a waiting time of under a minute.

4. Hospitals aren’t hotels

Need a stay in hospital? Make sure you come equipped. Many hospitals don’t issue basics like towels, gowns, soap and other toiletries, so you’re expected to bring your own. If you find yourself in hospital after an emergency, you’d better hope you have a friend who can bring in your pyjamas quick-smart.

Make sure you’re covered with ottonova’s expat health insurance

5. Medical degrees are mandatory… for the patient

Well, not really. But it might feel like that at times, thanks to the German medical tradition of issuing diagnoses with their Latin names (a practice known as Fachchinesisch). It can be hard to prise more detail out of your doctor in layman’s terms, particularly if your German isn’t much better than your Latin, but don’t start worrying if they brush you off with “everything’s fine” – it’s likely that convoluted Latin term simply meant you’ve got a cold.

If your German – or Latin – isn’t up to scratch, ottonova’s 24/7 Concierge Service is always on-hand to offer further explanation. Mirabile dictu!

6. Spas aren’t just for fun

Photo: Alan Caishan / Unsplash

The culture of going to a therapeutic spa (das Bad) is a long-standing one in Germany, with many people believing ‘taking the waters’ can help cure or prevent your maladies as much as any medicine. So much so that you might find your spa break is covered by your health insurance (always check first). Likewise, naturopathic and homeopathic remedies, massages and other natural cures are often covered — and are with ottonova’s health insurance for expats without any additional costs.

7. Prices won’t break the bank

Though healthcare isn’t free in Germany, costs are generally covered by your public or private health insurance, usually without a deductible, and are considerably cheaper than in other countries. So while the monetised nature of health may still be a culture shock for Brits used to receiving free treatment under the National Health Service, others, particularly US expats, may find themselves pleasantly surprised by how reasonable the cost of healthcare and medications can be in Germany.

In some cases, ‘going private’ may even be cheaper than public health insurance as the amount you pay for public health insurance depends on your income, so higher earners end up paying more. However, if you opt instead for private health insurance, the costs are calculated based on your current health status so could be even cheaper than public health insurance.

This content was produced by The Local Creative Studio and sponsored by ottonova.

For members

HEALTH

How to find available therapists in Germany

It’s no secret that mental health care can be particularly tricky to access in Germany. Here are some helpful tips for anyone who is struggling to book an appointment for therapy.

Published: 23 April 2024 12:55 CEST
How to find available therapists in Germany

The process to find psychotherapy in Germany’s urban centres is arduous – licensed therapists often have impossibly long wait times, and private practices don’t accept public health insurance.

A major reason that public insurance funded mental health care is hard to find in Germany comes down to regulations. Specifically the ‘coverage plan’ (Bedarfsplanung) that basically limits the number of licences available for publicly insured therapists in a region.

Germany’s maddening bureaucracy probably won’t be fixed any time soon. So residents in need of therapy will need to find a way through the system as it is.

So here are a few helpful tips for finding therapists, as well as how publicly insured patients can have private practice therapy costs reimbursed.

Look for therapists enrolled at academies

You’ll probably have a better chance getting an appointment with therapists who are currently in training, because not everyone knows that this option exists.

You can search for “Akademie für Psychotherapie”, to find one in your location. The Berliner Akademie für Psychotherapie, is one in the capital city, for example.

If you arrange an appointment this way, you can expect to be connected with a grad student therapist in training who needs to complete their supervised practice hours. In this case, you would see your therapist as usual, and they will be going through your session with an experienced therapist afterward.

The main advantages to seeking a therapist in training is that it may be cheaper and you can probably more readily find an appointment. A potential disadvantage is that the therapist you’ll be seeing is less experienced. 

But according to a Stockholm University study, student therapists who receive regular feedback from supervisors may be just as effective as licensed therapists at treating patients.

How to get reimbursed for going to a private practice

As mentioned above, therapists covered by public health insurance are few and far between, especially in many urban centres, and therefore regularly come with long wait times. But for those willing to do battle with the bureaucracy, there is an option to have your costs reimbursed for seeing a private practice therapist.

Specifically, public insurance providers are obligated to provide full reimbursement of costs in the event of a “supply emergency”. 

Waiting times of more than three months are considered unreasonable. So generally, patients can claim a supply emergency if they have contacted several therapists, and none of them offered available appointments within that time frame.

But you’ll want to make sure that your process is properly documented so that you won’t be stuck with the out-of-pocket costs.

First, you’ll need to document your need for psychotherapy. To get this, make an appointment for a psychotherapeutic consultation with a practice in your area, and be sure to collect a written recommendation for treatment (a PTV 11 form). 

If you don’t know where to start with this, look to the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) for a database of therapists. You can also call 116 117 or use the 116 117 App.

After you’ve got your PTV 11 certificate, you’ll need to document your futile search for a licensed therapist. To do this, contact at least three to five therapists that have public health insurance approval. Keep a list of the names of therapists you contacted, as well as dates and times of contact and how long the waiting list for treatment is. 

Additionally, you should try to arrange treatment through the aforementioned Association of Statutory Health Insurance Physicians, and receive confirmation if it’s not possible. So you’ll need to call 116 117, or use the 116 117 App again. But this time go through the process to have them try to find you placement with a therapist. This should take a maximum of four weeks, but rarely happens.

Finally, if you have documented all of the above and have still not found a readily available therapist, then you can seek out a private practice. You’ll need to enroll as a self-paying patient initially, but then you can submit an application for an outpatient reimbursement (Kostenerstattungsverfahren) along with the previously collected certificates and proof of your search. Private practice therapists are usually familiar with this process, and may be able to help you with the application as well.

READ ALSO: What are the main reasons internationals in Germany turn to therapy?

Free phone consultations for students

Students in Berlin can also take advantage of a free 50-minute conversation with a therapist through StudierendenWERK.

For students elsewhere, it’s worth checking what kind of mental health support services your school offers. Many German universities offer mental health support to some extent, and if school counsellors can’t provide the care that you need, they may be able to offer helpful information about where such services are available in your area.

READ ALSO: Here’s how you can get mental health help in English in Germany

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