The UK and German healthcare systems compared

I’m a coach in languages and so I am keen to explore languages – especially German. I want to provide useful content for a wide audience on issues concerning the UK and Germany.

Following a suggestion from a colleague, I decided to look at the question of the UK’s National Health Service and how it compares to the health system in Germany.

I’m giving a very brief overview of a complex subject. I’m going to give some personal opinions as well as general information based on my research. There are some statistics as well. I’ve tried to ensure everything is factually correct, though some information may go out of date.

Which health system is better? The British NHS or the German healthcare system?

It’s complicated! So let’s look at some key facts, and by the way I’m going to give some useful words and phrases in German later.

OK, so what is the fundamental difference between the UK system and the German system?

The UK NHS is owned and run by the state and it’s free at the point of use.

The German system is mostly free at the point of use but it’s paid for through contributions to a health insurance scheme that’s closely regulated by the state.

In Germany people pay for the health system by paying social insurance contributions into a health fund – Gesundheitsfonds . The money then goes into a Krankenkasse or health insurance ‘pot’. The money is taken directly from salaries and the employer also contributes 50%.

In the UK, the money to support the health system is provided by the government, mostly through general taxation.

The NHS was launched in 1948 at what was then Park Hospital in Urmston near Manchester. Today it’s Trafford General Hospital. A blue plaque commemorates the launch.

British people are proud of their NHS and often compare it unfavourably to the US system. They like the fact that it’s free, unlike the American system which relies mostly on private health insurance.

Aneurin Bevan – he was from Wales and that’s a Welsh name – was Labour health minister and he is credited as the father of the NHS. A statue of him is in the centre of Cardiff, on Queen Street.

The UK system is more like the old East German system and that’s not a criticism. The East German health system provided a good, basic service, though without the expensive equipment found in the West.

After the end of Communism – nach der Wende – the West German system was introduced into the East.

The German system goes back to the late 19th century, when under Otto von Bismarck, Germany pioneered the welfare state.

This system is still in use today. Krankenkassen are non-profit making organisations, that are governed by strict regulations.

The biggest state-run Krankenkasse is the Allgemeine Ortskrankenkasse. There are many private Krankenkassen offering a range of packages at different contribution levels.

You are required by law to pay into a Krankenkasse. You can see it on your pay slip. If you earn above a certain amount, you can insure yourself with a private Krankenkasse. Many cater for specific professions.

In the UK, the National Health Service is paid for by the government. The amount paid by the government varies depending on which political party is in power, whether Labour or Conservatives or a coalition.

Statistics indicate that the NHS received considerably more money under Labour governments than the Conservatives, though the Conservatives dispute this.

It’s important to note that the UK also has a private healthcare system which people can gain access to by paying for private health insurance. People also receive private healthcare as a benefit or ‘perk’ of their job.

So in theory, whether you are in Germany or in the UK, if you have a higher income and/or a better job, you can get better healthcare by paying more. To what extent that is true lies outside the scope of this essay!

The NHS has had a funding crisis for many years – German system is not perfect but it’s well-funded.

Due to Brexit, the NHS has a serious staffing crisis and it’s getting worse. Many staff have left and fewer people than before are being recruited from the rest of Europe. A no deal Brexit would be very bad for the NHS for many reasons.

How much do both countries spend on health? Germany spends 11.1% on health care, the UK, 9.8%.

Which hospitals are reputed to be the best in the UK and in Germany? I don’t think it’s possible to give a reliable answer to that question, but here are are some well-known ones: in the UK, Guys Hospital in London is famous, also Queen Elizabeth Hospital Birmingham, The Christie in Manchester and more.

In Germany the Universitätsklinikum Heidelberg, the Charité in Berlin, Asklepios Klinik Barmbek – Hamburg and the Uniklinikum in Köln are all highly regarded.

What are the practical differences between UK and German hospitals? To find this out, I went for a walk around a few hospitals in the UK and in Germany.

One thing I noticed walking around the Uniklinik in Cologne is that each department or unit functions as an independent practice – eine Praxis . I saw a children’s emergency Praxis behind the main building.

In the UK most departments and units display the NHS logo. Services based around for instance, a hospital or the local ambulance service are organised as an NHS trust. This arrangement is intended to provide more autonomous control. Some medical services are provided to the NHS by outside companies, for instance Fresenius, a German-based company.

At UK hospitals you’ll see adverts for fundraising – which is often needed to pay for basic hospital equipment, such as scanners.

In Germany you just don’t see this, pretty much all main medical services in Germany are fully funded.

This is especially true of hospices. St Ann’s Hospice near Manchester receives just over a third of its funding from the NHS. That means it needs to raise around £20,000 every day just to keep the hospice running.

They organise glamorous celebrity dinners, midnight runs and many other fun events. They operate charity shops as well, but is it right that a facility providing a basic healthcare service needs to do this to raise money?

In Germany hospices are fully funded.

Here are some more differences I found:

The emergency ambulances in Germany have a two-tone sound, but in the UK, they have an oscillating tone. The German siren is called the Martinshorn, named after the company that makes it.

In the UK the emergeny ambulances are yellow and green and in Germany they’re red, like the trains. In both countries you often see the same basic vehicle, the Mercedes Sprinter.

On the side of the ambulance in the UK, you’ll see the emergency number 999 and you can dial 111 for non-emergency medical issues and advice.

In Germany and other mainland European countries, the emergency number for fire brigade and ambulance is 112. The 112 number also works in the UK and on any GSM phone anywhere in the world.

In recent years, smaller hospitals have closed and their services, including A&E have transferred to larger single-site hospitals.

This means ambulances have a longer distance to go than before. I hear many ambulances passing every day in the UK but when I’m in Germany, I seem to hear fewer? Is that really the case? I’m not sure.

Parking at hospitals is an important issue. At German hospitals, it’s generally free for a period, then there’s a charge.

This is also the case in Britain, though some have very expensive charges, for instance Stepping Hill hospital in Stockport.

If you are a citizen of another EU state visiting Germany,  you can receive healthcare on the same basis as German nationals

Thanks to the UK’s membership of the EU, citizens from other EU nations are treated for free by the NHS – or more exactly, the NHS charges the cost of the treatment to the home country.

And UK citizens travelling in the rest of Europe can receive treatment on the same basis as nationals. It’s not necessary to take out medical insurance, as you do when travelling to the United States, for instance.

I once had a bike accident in Germany, and I was given first class treatment at the local hospital. The bill of 233,50 Deutsche Mark was charged to the UK and I didn’t have to pay anything.

If you’re from the UK and are unfortunate enough to suffer illness or an accident in Germany you’ll be able to gain first hand experience of healthcare in Germany and so you’ll be better able to answer the question of which has the better system, the UK or Germany.

But before I come to that question, I’m going to give you a short German language lesson.

What do doctors ask you when you go and see them?

Doctors in the English speaking world say ‘What seems to be the problem?’ or ‘What can I do for you?’ or maybe ‘How can I help you?’

German speaking doctors might ask you ‘Was fehlt Ihnen?’ – What’s wrong with you, literally what’s missing from you? Also ‘Was kann ich für Sie tun?’, What can I do for you? or maybe ‘Wie kann ich Ihnen helfen?’ – How can I help you?

Let’s look at a few complaints
Ich habe Kopfschmerzen. – I have a headache.

Ich habe Halsschmerzen. – I have a sore throat.

Ich habe Magenschmerzen. – I have a stomach ache.

If the pain is coming from your hand, foot or leg you can say ‘tut mir weh’ – (it) hurts

Meine Hand tut mir weh.
Mein Fuß tut mir weh.
Mein Bein tut mir weh.

For other parts of the body, consult a good dictionary!

If there’s been an accident and you need to phone 112 you can say:

Es gab einen Unfall. – There’s been an accident.

Es gibt Verletzte. – There are injured people.

Okay, so let’s get back to the important question: Which system is better, the UK healthcare system or the German health system?

In doing my research I found an interesting video on the BBC website (link below) with some interesting information:

• Waiting times for operations are shorter in Germany, typically three to four weeks in Germany.In England most people wait 22 months for orthopaedic operations.
• Germany has three doctors per 1000 population, but the UK has two.
• Germany has three times as many hospital beds compared to the UK.
• Germany spends 11.1% of its GDP on health, Britain 9.8%.
• Most Germans pay 7% of their income for healthcare. Their employer pays the same.

Most people I’ve spoken to who are familiar with the German healthcare system say it offers a higher standard of service. But people in Germany have to pay for their system directly out of their salary. Some  pay many hundreds of euro each month.

The British healthcare system provides a good system too, and though people don’t pay contributions directly towards the health system, the NHS is paid for through taxation and a share of National Insurance contributions.

Despite its current difficulties, the majority of people in Britain are proud of their health service and they appreciate the work done by medical professionals at all levels. By and large they still support the original idea of the NHS, that is, to provide free universal healthcare and most people are reluctant to move towards a US-style system.

So that’s it, a quick, hopefully informative and maybe entertaining overview of a very complex subject. I hope it will arouse your curiosity and encourage you to look for more detailed information online.

If you’re interested in learning German, go to www.aidan.co.uk/german/.

If you’re visiting Germany, I wish you gute Reise! and if you’ve visiting the UK, enjoy your trip. And to all EU nationals visiting another EU country, don’t forget to bring your EHIC card!

Here’s the link to the BBC video I found.