Health Services and Insurance - particularly but not exclusively in Germany

I must admit to once having a certain naïvety when it came to the cost of health insurance.

In 2008, about 4 to 5 months before I had my heart attack, I was facing a situation where I was living principally in Germany, and working in France and needed medical cover for myself in both countries with additional coverage for my wife in Germany.

Health service coverage in both countries is excellent normally. Given that my earnings were not overly substantial, going through the German national health service made sense from nearly all points of view, given that they also allowed international incident coverage.

Which was all well and good, except for the fact that the employer in France would not allow for coverage from Germany! For some obscure reason (don't look for logic in this), you could be covered from Spain.

Problem not resolved, I went to look at private medical insurance offers to cover both France and Germany on the Internet. I found one figure of €340. This is where the naivety stepped in. For some obscure reason I assumed that this was an annual cost. Rereading it, it became obvious that it was per month.

Throw your hands up in the air, mutter the phrase "I am never ill" (ironical given what happened 5 months later!), and go back and look at alternatives.

Eventually I came up with an alternatively that allowed two lots of coverage, using this strange Spanish alternative in France, and temporarily at least, the German coverage for both of us in Germany.

In Germany there is no opting out, you are obliged to be covered for all medical costs. Some 80% of people here are in the state system, the rest are privately insured. Costs for the insurance rise rapidly as you get older, and women's insurance at child-bearing age appears to be more than for men. The company that my wife works for is expected to pay her for the first six weeks that she is ill, after that the state system kicks in. They pay a percentage, not the full amount of any earnings.

One illusion that needs shattering here. It is not free! If you are employed at least. A percentage of your salary is deducted every month and paid to the health insurance scheme. Should you wish to visit a doctor, there is a charge every quarter (starting in January, April, July and October) of 10 Euro to be paid. Then if you require drugs for your complaint, they cost as well - so last month my wife had to pay a further 8 Euro 40 for something to help cure pains in her shoulder for example. In the UK, payment for prescriptions is also required in most cases, I believe.

The treatment here is good, reliable and would be expensive if you needed to pay for it yourself. I also think that it is more thorough than in the UK for example. When my father had had his heart attacks in England, they decided when he was ready to go home.

When I had mine, after the nightmare of 26 days in hospital (including 3 operations), they sent me off to a rehabilitation clinic for a month. The impact of that incidentally is well worthy of praise, you definitely have a more rounded recovery process.

Total cost of all this I accidentally discovered was some €17,940 which I could never have found out of my own pocket but is substantially less than I have spent in state insurance premiums over my lifetime (during which I have made a point of staying away from having medical treatment except when absolutely essential. And even then, reread my previous item where I went to work for 2 days after having the heart attack, and would not have gone to the hospital or had the treatment if my wife had not insisted - somehow you get through, and the income from work is necessary!).   

One curiosity is that the German national health system has been in place in one form or another since Bismarck at the end of the 19th century! And you don't get much more conservative than Bismarck. The apparently conservative logic of the time goes:

1. If you are to have a successful military you need fit, strong, healthy young men to fight for you. So keeping your population healthy makes sense from that perspective, and when most of the private soldiers in the front line come from the poorer sections of society, keeping that sector healthy becomes significant. (Not sure incidentally if they were aware at the time that infant mortality among boys was higher than among girls). 
2. A successful industrial nation needs a healthy workforce to do all the jobs that make the country prosperous. It benefits companies and makes them profitable not to have people skiving off sick.

Which are thoughts to ponder.