Speaker 1: In this video, I will immerse you in the nuances of the German healthcare system, focusing on private healthcare amidst a society often perceived as envious. Are you an expat living in Germany or about to move to Germany? Then you are or will be confused about our healthcare system. We have a dual one. We have public healthcare and private healthcare. How does envy come into play here? Private healthcare might offer you benefits over public healthcare that will many Germans drive up the wall. Only a few people have the privilege to opt for private healthcare. Generally, only those who are self-employed, who are civil servants, and those with a gross income above €69,300 per year. Sadly, it is part of German culture that people regard the success of others with resentment and are less willing to accept or celebrate individual achievements and prosperity compared to other cultures where success might be celebrated more openly. In case you have never heard about this cultural trait of ours, we have an idiom and it goes like this. Pity is given for free. Envy must be earned. If you don't believe me, just have a look at the comment section. I'm sure, pretty soon, you will find German culture in a nutshell there. My name is Stefan Bundhorg. I'm a board-certified urologist and sexologist working within the German healthcare system. So why would anyone consider private health insurance? First of all, it's incredibly cheap in comparison to public healthcare. At least when you are young. Because you will only pay for your personal risks. When you are young, you are generally healthy. So no risks for the insurance company and very low monthly payments on your side. As opposed to public healthcare. Because here, with a few exceptions, everyone pays the same share, regardless of whether they are sick or not. This system works in a way that should you get sick, the costs will be covered for you. So you have no right over the money you pay into this system. People often say, I've paid so much money into public healthcare but I was never sick. Now I want to get something back. But that's not how this system works. You are not entitled to a refund. Here is where envy comes into play. As a private patient, you are much more likely to skip waiting lists. It's still not easy to get an appointment within days, but it becomes easier. As always, it has to do with money. Doctors used to get paid more for private patients. However, the tariff for doctors for private patients has remained unchanged since 1996. In public healthcare, it has been adapted to inflation, etc. so that the difference between the two tariffs is not a big one anymore. The other reason is that doctors working in public healthcare only get paid once a quarter for each individual patient. If the patient books an appointment a second time during that quarter, they are obliged to treat him without reimbursement from the system. That's different in private healthcare. It doesn't matter how often a patient shows up during a quarter. He may be billed for each visit. Having worked within several healthcare systems myself, I think that the advantages of a dual system outweigh the disadvantages. Scientific progress and advances in medicine are paid by private healthcare first, as a rule, which results in pressure to acknowledge them in public healthcare as well. Private healthcare subsidizes public healthcare because without the income from the private sector, doctors would have a hard time balancing their costs and income. I don't think waiting lists are a problem. We are still in a comfortable situation here as opposed to other countries. But a real advantage is the access to specialists. If you get really sick, and your life depends upon it, and you want a second opinion from this one specialist, it might be easier to get when you have private insurance. Apart from that, there are also a number of disadvantages. First, you have to pay for every member of your family. In public healthcare, spouses who are not employed and children are free. Secondly, your monthly payments increase with age. By the time you retire, they are usually sky high. What I am hearing from my patients right now is that you have to calculate with 1000 euros and more per month. In public healthcare, you still pay the 7.3% of your pension, just like if you were employed. The high payment rates in private healthcare can create a real financial problem. Because once in private healthcare, it becomes increasingly difficult to get out. Once you turn 55, it will not be possible anymore, no matter how low your income is. So you really have to think before you sign private health insurance. Another problem is reimbursement. In public healthcare, patients never see a doctor's invoice. In private healthcare, they will. They have to pay the invoice, hand it over to their insurance company, and get reimbursed. The insurance company could refuse reimbursement for several reasons. So you would have to pay parts of your invoice yourself. It depends a little on your personal contract and on the treatment. With the tariff not having been adapted to inflation and medical progress, this has become an ever-increasing problem. Because many of today's therapies are not listed. This is because the tariff was created in the year 1983 and has remained unchanged since then. It's a little crazy, isn't it? So you see, also Germans can be a little crazy. Thanks for watching. Bye-bye.