By Laura Muncie
For the British public the NHS is a diamond in the welfare system crown. UKIP with the “£350 million for the NHS” bus slogan, is an example of how frequently it is seized upon for political leverage.
Whatever political group convinces the public they will do more for the NHS – wins. The NHS really matters to UK voters.
Given the political clout it carries the NHS is regularly under the microscope. Healthcare discussions are bread and butter reporting for the UK media-in a way that I have not seen elsewhere.
Place anything under the microscope and you will find cracks and the UK media are experts with a magnifying glass. First Minister Nicola Sturgeon is routinely put through a political workout in defending the Scottish Government decisions on healthcare, despite studies that show Scotland has the best performing NHS in the UK. Nuffield Trust
Focusing on Scotland’s NHS has become a press obsession. Critical comparisons with healthcare on the Continent, especially over waiting times are common, but comparisons on waiting times don’t tell the public much about healthcare costs.
How much do the public really know about healthcare in other countries beyond the headlines?
If the funding structure of NHS Scotland were to be changed, what could be an alternative model?
Here is how German standard healthcare stacks up against the Scottish NHS.
My healthcare is provided by one of the largest most commonly used German healthcare providers – TK.
I pay €177.12* a month(around £156.34**)for basic German healthcare as a self employed worker.
Last year I paid €174.04* a month. Each year this cost is reviewed, and the Government decides if an increase is needed. This year it was increased.
My monthly payment is the lowest cost plan for a part time self employed worker. Full time workers will pay more. I am on the cheapest tariff, my husband pays double for the same benefits.
Healthcare costs are not paid via your taxation like in the UK. The money is taken directly from your wages or bank account and used to buy an insurance policy. Health Insurance is required by German law.
What is and isn’t included in the monthly cost?
Included for children, but working adults pay for prescriptions. Here is a recent receipt.
€5 for a course of antibiotics.
€7.68 for 3 month supply of Thyroid tablets. Neither item carries a charge in Scotland.
My insurance allows 2 check-up blood tests a year. I recently had an extra set of blood tests done at my GP for a cost of €15. Blood tests do not carry a direct charge in Scotland.
Cover includes 2 check-ups a year. A professional clean is at additional cost. Fillings are covered for certain filling materials only. If you wish better quality that is an additional cost.
There is an additional €10 per night *for staying in hospital, capped at € 280* per year. I was in hospital for 3 weeks last year so had a €210* fee on discharge. An exception to this is a hospital stay to give birth. If your child is stillborn however, the €10* daily fee applies. You are charged for internet access in hospital.
There is no direct fee for hospital admission in Scotland.
Ambulance call out charge
If you call an ambulance you have a €10* fee. No call out fee in Scotland.
You cannot buy basic medicines in a German supermarket only a chemist. Basics are more expensive compared to Scottish supermarket prices.
German Paracetamol pack of 20 tablets €2.85.
Tesco pack of 16 tablets £0.30.
I buy basic medicines in Scotland because of the favourable prices.
These are included in the healthcare plan if you go to a specified Ophthalmologist. If you need glasses, the cost of the glass is covered, but not the frames.
You must find and register with a Gynaecologist in Germany because GP’s generally don’t take responsibility for pre and post-natal health. 3 ultrasounds are included in the monthly payment. Smear tests, breast scans and genetic tests are covered if the Dr believes you need them. Tests that are standard with the NHS might not be in Germany.
The Scottish NHS has linked together it’s services. German clinics operate as separate independent service providers. Your GP will not treat your child for example, you are required to find and register with a pediatrician. The clinics operate their own opening hours and can turn away new patients if their patient lists are too long.
In Germany you have to find your own midwife to carry out your prenatal tests. A hospital will provide you with a telephone list and you have to call around yourself. There is a midwife shortage in Germany, I was lucky to find my midwife, who was only available due to a cancellation.
Many clinics carry a small one time registration cost.
I would like to say more about the differences having used both the NHS and German healthcare but broadly speaking accessibility to services, link up of services, and direct costing are the main differences between the NHS and German healthcare.
Here is my healthcare bill from 2017. I am on the cheapest tariff for a part time self- employed worker.
- € 174.04 x 12 months insurance €2088.48*
- Hospital admission 21 days €210*
- Thyroid tablets for 1 year € 30.72*
- 1 set of antibiotics €5*
- Registration fee at clinic €25*
- Ambulance fee €10*
Total: € 2369.20 * or £2091.81** in GDP
£2091.81 a year, in Scotland that cost is already paid via tax. Based on my income I would be exempt from paying income tax in Scotland, so in effect the NHS would be free for me. But with the German healthcare equivalent it is not.
Here is an illustration of how it would cost if the TK German model was applied to a full time employed worker in Scotland based on the median gross salary in 2017. The median gross weekly wage for a full time worker in Scotland in 2017 was £442. Earnings in Scotland: 2017 SPICe Briefing
£442 a week for 52 weeks is a salary of £22,984. An approximate monthly gross salary of £1915.33
In Euros that would be €2169.31**
TK have an online insurance calculator tool. After using the tool and speaking to their specialist on the phone, the plan cost using €2169.31** is €210.96 a month.
A healthcare bill of £2235.12 ** a year when you convert it to pounds. An employer would remove that money from salary as part of salary sacrifice. Prescriptions, hospital stays and other fees are additional, so the real cost under a German system would be higher than the £2235.12 .
So if you can compare the two systems, the NHS is not really “free”but costs are met by paying tax. Germans still pay taxes but also must pay a healthcare cost.
Recently I received good service at a Scottish GP surgery. I was seen the day I called up and didn’t have to pay for my prescription. Despite waiving my German € 2369.20 insurance card at the receptionist, there seemed little concern about needing it.
Perhaps this ease of access for non residents should change post Brexit, when Scotland enters a 3rd country relationship with the EU. In Germany you don’t get treatment unless you prove you’re insured, it is the first thing asked for.
If you work full time you can get an estimate for a TK healthcare policy here. Typing in your gross monthly salary in the left hand box.
*Figures are based on TK healthcare service provider.
** Exchange rates dated 27.06.18