Healthcare in the UK and Germany compared.
A visual podcast by
Aidan O’Rourke
in English with some German words and phrases.
Subtitles in English & German
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I am a coach in languages and I’m keen to explore issues concerning the UK and Germany.
This presentation is mostly in English but I also include some examples of German words
and phrases to do with healthcare. You can’t talk about healthcare in Germany without using
some German. Following a suggestion from a fellow pro-European
campaigner, she was campaigning in favour of the NHS, I decided to look at the question
of how the UK’s National Health Service compares to the health system in Germany.
This is just 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 not be
completely accurate and it will go out of date.
So which health system is better? The British NHS or the German healthcare system?
Es ist kompliziert! It’s complicated! OK, so what is the fundamental difference
between the UK system and the German system? The UK’s 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. The money to pay for your healthcare is taken
directly out of your salary. The amount appears on your wage slip. This money goes into a
health fund - ein Gesundheitsfonds and then into your chosen Krankenkasse or health insurance
‘pot’. 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
called 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
they often compare it 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
from 1945 and he is credited as the father of the NHS. There’s a statue of him on Queen
Street in the Welsh capital, Cardiff. The UK system is more like the old GDR 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.
That 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 - which you could translate as the general local health insurance
organisation. It’s not easy to translate so we’ll just say Krankenkasse.
You'll find a wide range of private Krankenkassen offering a range of health insurance packages
at different contribution levels. You are required by law to pay into a Krankenkasse.
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. Statistics indicate that the NHS received
considerably more money under Labour governments than the Conservatives, though of course,
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.
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 now has a serious staffing
crisis. Many staff have left and fewer people than before are being recruited from the rest
of Europe. Brexit is bad for the NHS for three reasons:
The staffing problems, the effects on the NHS of a possible US trade deal and simply
the fact that the NHS is paid for through ongoing taxation.
Brexit is costing the UK a huge amount. Less money from taxation means less money for the
NHS. The claim by the Leave campaign that the UK
sends £350m a week to the EU and that this money can instead be paid to the NHS was false
and deliberately misleading.
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 there are certainly
some famous hospitals: in the UK, Guy’s Hospital in London, Queen Elizabeth Hospital,
Birmingham, The Christie in Manchester and more.
In Germany we would think of the Universitätsklinikum Heidelberg, the Charité in Berlin, Asklepios
Klinik Barmbek – Hamburg and the Uniklinikum Köln, are all highly regarded. And by the
way Klinik in German can refer to a hospital, not just a small health centre, as in English.
So what are the practical differences between UK and German hospitals? To gain an impression,
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. For instance I saw a Notfallpraxis - an emergency
practice for children and young people. In the UK most departments and units display
the NHS logo. Healthcare services including hospitals, health centres and emergency ambulance
services are organised under NHS trusts. An NHS trust is a non-profit making organisation
set up to provide healthcare services. As of April 2020 there are 217 trusts, and they
employ around 800,000 of the NHS’s 1.2 million staff, information from Wikipedia.
Many hospitals in Germany are run by religious organisations, such as the Evangelische Kirche,
Germany’s Lutheran Protestant church. Some medical services are provided to the
NHS by outside companies, for instance Fresenius, a German-based company that provides dialysis
services. 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 the 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 events. They
also run charity shops, 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 emergency ambulances are yellow
and green and in Germany they’re red, like the trains. In both countries you’ll often
see the same basic vehicle, the German-built 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 in the UK, smaller hospitals have closed and their services, including
A&E - Accident and Emergency - have transferred to larger single-site hospitals.
At hospitals in Germany, car parking is 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
This is one of the many advantages of EU membership. The cost of any treatment is charged to the
home country of the visitor. You can travel throughout the whole of the
EU plus some additional countries, and 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. I just showed them my British passport,
the bill was charged to the UK. I didn’t have to pay anything.
The loss of this intelligent and cost-effective healthcare arrangement for the UK and its
citizens, especially older people living in other parts of Europe, is one of the many
dreadful consequences of Brexit. If you’re from the UK and suffer illness
or have an accident in Germany, you will, thanks to Brexit, most likely have to pay
for it yourself, or buy travel insurance before you leave.
At least 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 country has the better system, the
UK or Germany. In the course of my research I found an interesting
video on the BBC website with some useful information:
Waiting times for operations are shorter in Germany, typically three to four weeks. In
England most people have to wait 22 months for orthopaedic operations. Orthopaedic, that’s
the branch of medicine that deals with problems of bones or muscles.
Germany has three doctors per 1000 population. The UK has two.
Germany has three times as many hospital beds compared to the UK.
Germany spends 11.7% of its GDP on health, Britain 10%.
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 euros each month. That’s
possible because of Germany’s strong economy. The British healthcare system provides a good
service, 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 a large majority they still support the original idea of the NHS, that is, to provide
universal healthcare that’s free at the point of use.
So that’s it, a quick, hopefully informative and maybe entertaining overview of a very
complex subject, which I hope will arouse your curiosity to find out more.
If you’re interested in learning German, go to www.aidan.co.uk.
Vielen Dank, thank you very much for watching, listening and reading.
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