Medicine in Germany

A few (English) tidbits lately about some aspects of medical care in Germany:

End of life: A healthy but elderly woman with no family, fearing ending her days in a nursing home, commits suicide with assistance. (NY Times)

Underpaid doctors: NPR reports that one way health care costs are kept down is buy strictly budgeting doctors' pay. (National Public Radio)

Mary's favorite employer, Frontline, does a piece on how various countries care for their sick, including Germany. (Frontline)

My (limited) experience?
Expect waits. Usually the wait is about 1/2 for a pre-arranged appointment. Calls on the day, to deal with an urgent sickness, result in a request to come in at a certain time, but don't be fooled - it's not really an appointment, just an attempt by the office staff to manage the stream of walk-ins, and you can expect to wait a LONG time - I've personally had 2 hour waits (with sick kids!). I'm told that if we had "private" insurance, we'd get quicker service.

Doctors do everything. This was one of the first things I noticed - the doctor performs all the elements of the exam - blood pressure, temperature taking, weighing, shot administration, etc. Only a few things, such as blood taking, are performed by specialists in the practice. I see little evidence of any equivalent of Nurse Practitioner or Doctor's Assistants here so far. That being said, there is also very little of the preliminary "checkup" that occurs at every US doctor's office I've ever been in - weighing, blood pressure taking, temperature measurement, recent medical history update. There seems to be the assumption that if you have some concerns, you'll speak up.

Computers - A lot more is computerized here. The doctors are mildly surprised when I hand over American doctors' records, which are handwritten, if you can call it "writing" at all. I don't know if the push toward computerizing the records came as a result of any push from health insurance ("sickness accounts"), but at each visit we do hand over an insurance card with a little chip on it with all our insurance information on it.

Pass Books - for a lot of things, such as children's exams or immunizations (adult too) there are pass books every doctor expects you to have. Not a big deal not to have it, I've found, although the pediatrician did go to a lot of trouble to translate the kids' immunizations into German.

Doctor's hours - are much shorter here. I imagine some of that is because of the house calls mentioned in the NPR account, but I do know most doctors also have hospital obligations, and as such need time to be off with those patients too.

Drugs - very small co-payments, usually, and no co-pay for children under 12, but over-the-counter meds are more expensive. That's partly because they are literally over-the-counter - you go to the pharmacy, describe your problem to the pharmacist, and he or she then suggests a remedy. Consumer help shows advice you to ask for a cheaper alternative to what's suggested; the pharmacist, also a salesperson, is under some pressure to sell you the more profitable items. I recently did this with my allergy meds and saved 40%. Prescription drugs are somewhat subject to "formularies" like in the States; that is, the insurance companies dictate certain brands for certain conditions.

Insurance - I've heard of doctors who won't accept the public insurance any more as they can obtain better payments for the (more expensive) private insurance which ~10% of the populations buys. I have also read that the private insurance gains you access to better specialists

My Overall Conclusion - the system is efficient but overtaxed, with far more need than available physicians (at least judging by the waiting rooms). Germany's population is rapidly aging (NY Times again) so I don't see that changing soon.