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.
Cost
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?
Prescriptions.
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.
Tests
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.
Dental care
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.
Hospital stays
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.
Non-prescription medicines
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.
Eye tests
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.
Pregnancy
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.
Service
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
Example Here
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Hi Laura, a very interesting and informative piece but how do quality of care, waiting times, A&E etc compare?
Hello Charlie,
Thanks for the comment, glad you found it interesting. That’s the whole idea !
The original article had some of the points you ask about but was double the length. I felt I was pushing it at 1000+ words so a lot of content was dumped and the focus was on cost.
I am thinking of a second article comparing the quality of care and how it is experienced, but it will depend on how many read this article if I do it.
Currently have around 6 articles in the pipeline you see, so I have to prioritise.
Wrote this because I feel there is an information deficit among the UK public about a lot of topics outside of the UK. For instance today I came across evidence that the UK could always control migration from the EU, but chose not to. How widely known is what by the public ? and EU migration is helping the NHS recruit skilled workers. So there is a lack of quality information reaching the public in my view, and whatever does seems to be a rehashing of former ideas and the analysis is poor. Thankfully the ON breaks out new ideas.
Cheers, Laura
sorry I meant Charles ! It has been a long night writing 🙂
Laura, no problem I often sign myself as Charlie or Chas.
Also taxpayers also pay NI which is to an extent similar to the monthly health charge by the German health system.
Hi Jim,
NI was originally set up as an insurance to help with illness but it then expanded to cover pensions and many more state benefits . The German healthcare price only covers healthcare not pensions. So NI payments in the UK are not an equivalent to German health Insurance.
https://www.gov.uk/national-insurance/what-national-insurance-is-for
“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.”
Phew, Laura, your article is an eye opener, but, to me, that sentence is the rub – if there was no NHS, and it was up to people whether they chose to/could afford to get Health Insurance ( as happens in Ireland), that would be one thing. To have it forcefully taken out of your wages, based on whether the Government thinks you can afford it, and that amount possibly being raised, on review by them, is another matter. As you say – “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.”
There are so many things wrong with the system you describe. Just to pick out one – a charge to call out an ambulance, could mean that folk hesitate – time can be of the essence in these cases ….
It could be said that it might stop people calling ambulances unnecessarily (which, unfortunately, does happen), but – who’s to decide what is necessary? And, it’s better to be safe, than sorry – it’s a trite thing to say, but it’s true.
I could witter about it – I don’t need to, as you’ve written a very clear article.
What I will say – not to you, but to the readers – is
“You don’t know what you’ve got, ’til it’s gone.”
Exactly. A good point why a ‘free at point’, ‘catch all’, ‘everyone included’ system is better. Equally often this is what saves money for the NHS. Someone down on their luck, at a bad point in life, doesn’t seek primary healthcare- either because of fear of costs of prescriptions (already seen in England where even some diabetic supplies have been removed from the free exemption now), or because other stresses mean even thinking about costs is too much. The issue gets worse, and now something that could have been stopped by a (relatively) cheap consultancy, and course of treatment, now requires emergency care- Ambulance, time in hospital, scans, blood tests, possibly operations and could even lead to organ failures.
Not to mention needing staff- who do not enter the profession to checkup if people can pay! Stress of paying bills after leaving during recovery can also hamper recovery itself.
No matter what way you twist it, there is no such thing as a free lunch. I take it that in Germany if you are not earning then unlike the US you will get care?
Hi Charles,
Apologies for the slow reply. I have been writing a lot.
Glad of your question as trying to answer it I also learned more about the health tests included under my current non private German healthcare plan. You may wish you had never asked as the reply is quite lengthy.
Getting healthcare when unemployed depends. If you are married you have cover under your spouses insurance plan at no extra cost to either of you. This is called a family policy.
If you are single or unmarried, you can access the healthcare system via your unemployment insurance. Compulsory by law this is an insurance paid for partly by your employer, and partly by you as an employee while working. Having paid that insurance (for long enough) allows you to access benefits including healthcare if you lose your job.
Students also have to have healthcare insurance but it is cheaper for them to buy it.
There are few scenarios where you can walk into a clinic and get treatment without an insurance card. When your status changes the insurance provider updates your insurance card. That insurance card is the first thing asked for in any clinic or hospital. In short funding your healthcare when an unemployed adult happens during your employment.
There js more info in the link below, what it refers to as ‘state healthcare insurance’ is the insurance I talk about in my article. People have suggested that my examples use private healthcare costs. They don’t.
http://ec.europa.eu/social/main.jsp?catId=1111&langId=en&intPageId=4549
As a side note, was at the dentist yesterday for my routine checkup – allowed under my non private policy. I need a scale and polish. It will cost an additional €80 as it is not covered by my plan.
Need to wait until next month to pay for that !
The comment about getting access and Scottish GP not worrying about your insurance. I get this, the trouble of balancing that when they likely have local residence going abroad and cost of processing for likely the only person that year in their surgery from outside Scotland needing care i likely not worth it.
I’ve worked in London before and differences can be seen there. I’ve seen them turn away (resident) screaming newborn babies (<1 week out of hospital) until they have registered… and brought in passports before they will allow them in the 'queue' to see a GP. I say passports, I mean PASSPORTS. This was my GP, they wouldn't let my partner, who hadn't left the UK as an adult so had no current passport (back in the days children could be added to parents passports), onto the patient list. She had her driving licence, NHS number, NI Number, name & address of previous GP in Scotland, council tax bill, utility bills, yet they refused to even have a form to fill in until they saw a passport- another tax on healthcare access. Same happened later to someone who needed surgery, but couldn't get registered for it as they weren't on a local council tax register (lived between two places and due to the issues with housing, wasn't on it in that area as landlord only wanted one tenant on all document's).
Even the differences between E & S are bigger than many might think. Second time working in London I was up and down frequently- so I didn't re-register in London. It was only for a short period, and my records took 8 months to cross the border the first time. Still caused issues, but fewer. Not only are we fortunate with the NHS, but the sNHS is even more significant (which was formed well BEFORE the claimed date of the first NHS in rUK, under another name and slightly different coverage).