Health Insurance, Waiting Lists, And The Media

My sister finally has a therapy placement – starting December 2012. That’s quite a long waiting time for someone who needs helps – ideally as soon as possible – but hardly unusual here in Germany, because of our health care system.

Health insurance is mandatory here for every employee and a couple of other groups, for example university students. We have a system of two different health insurances: one is called “legal health insurance”, where you pay a monthly fee on a sliding scale according to your income and receive the “standard treatments”. Additionally, we also have a so-called “private health insurance”, where you pay a fee based on your personal risk (age, sex, occupation, pre-existing illnesses, etc.). I’ll call them LHI and PHI in this text respectively.
The majority of Germans have a LHI, as it usually is a little cheaper and also covers spouses and children who don’t have an income of their own. In LHI, all the covered treatments are specified by law, whereas in PHI, you make individual contracts with the insurances, so that their coverage and fees can differ vastly. Also, for LHI patients, the doctors will get their money directly from the insurance company, whereas PHI patients often pay out of their own pocket first and later get that money back from the insurance.
The LHI pay a doctor € 40.- for each of their patients they see – for each quarter year, no matter how often these patients use their services during this time. Individual treatments are reimbursed separately, of course, but for a PHI patient, the doctor gets money every single time they see him or her, just for saying hello. Also treatments for PHI patients usually bring the doctor more money (because they pay more for their insurance, they also get more fancy treatment options), which leads to some health care practitioners opting to see exclusively “private patients”. Doctors are giving the PHI patients preferential treatment since they want to keep their “money cows”, which results for example in them having much shorter waiting lists etc. for specialists, if any at all, while the LHI patients will have to stand in line.

This is, in a nutshell and somewhat simplified, the current situation in the German health care system. Psychotherapy is very time-consuming and expensive, so that in this sector you have a large percentage of therapists who’ll see PHI patients only, and the waiting lists for the remaining ones get even longer as they are hopelessly out of capacities. Waiting a year and longer for psychotherapy is pretty much the standard – unless you’re an affluent private patient willing and able to shell out money.
My relatively quick start with therapy (six weeks from the first phone call to the first session) and the programme I attend are only possible because my data goes into a study which looks into establishing CBASP as a standard method for treating chronic depression for the LHI and the costs for it are covered by third parties, so I was very lucky to qualify for one of their vacant spots. Had I not taken the route via this programme, my earliest possible session would have been in April, and I would only have been granted the standard therapy. I hit jackpot in this regard. Unfortunately, my sister has no such luck.

It goes without saying that in my opinion such long waiting times are scandalous, and recently it has come into the focus of the media too. Ralf Rangnick, a high-profile football coach, suddenly resigned from his job mid-season because of Burnout Syndrome (even though he never used the word in his official statement), so that now it’s a frequently discussed topic and concerns are being voiced that it takes entirely too long until mental health patients are receiving adequate treatment.
Whether the attention will bring lasting change remains to be seen. When Robert Enke, goal keeper of the German national football team, successfully committed suicide after years of severe depression in 2009, it very much highlighted the topic for a while, but eventually the media moved on, and so did the public interest. It’s become but a tragic footnote in the history of German sports.


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