VOCATIONAL ORIENTATED CULTURAL

AND LANGUAGE PREPARATION

1. Key features of the healthcare system

Most aspects of health care in Germany are free for all those with health insurance, which is compulsory for everyone including foreign residents. There are two types of health insurance: statutory and private. Employees are legally required to be insured within the statutory scheme if they earn less than €4,462.50 per month (2014 rates). Those earning more or who are self-employed or civil servants (Beamte) may take out private insurance. In the statutory system, employees and employers each contribute 50% towards insurance payments. A certain percentage of monthly income has to be paid to the statutory insurance, with the exact percentage depending on the amount of money that is earned. With private insurance, the monthly premiums depend mainly on the age and health profile of the individual concerned.

When going to see a doctor, evidence of health insurance needs to be provided. European citizens need a European health insurance card (EHIC) to receive emergency medical treatment. For basic medical treatment the “S1” document is required. Both of these documents are issued by the health care insurance company in the country of residence or origin. Without an EHIC and/or S1 document, all costs of medical treatment – both emergency and basic – will be charged to the patient, though in some cases these can be reclaimed in the home country.

In most circumstances patients are able to choose the doctor who treats them. Hospital services are only offered in emergency cases, at times when doctors’ surgeries are not open (at night or at weekends) or, in severe cases, when recommended by a medical practitioner.

2. Particular features of the system relating to emergency medical care

The main emergency telephone number is 112. In case of a fire or other life-threatening situation (medical emergency), 112 (fire department and ambulance/paramedics) should be called. 110 is the emergency number to call the police.

If urgent medical assistance is not required in situ, patients may go directly to the emergency department or – in cases that are less urgent – call the statutory health insurance emergency number: 116117.

The emergency numbers 112, 116117 and 110 are all free of charge.

3. Significant constraints on the availability of emergency medical care

In life-threatening situations everyone is entitled to receive medical treatment. Emergency medical treatment for patients with an EHIC is covered by their home medical insurance. If patients do not have an EHIC, they will be charged by the hospital.

If emergency medical intervention is required, the patient will usually be transferred to the nearest hospital. Rescue times may vary from 5 to 15 minutes in towns and from 10 to 30 minutes in rural areas, depending on the distance to the nearest hospital and the equipment and resources of that hospital - for example, whether or not they have an air ambulance. First aiders will often be non-professionals. However, many people in Germany are first-aid trained eg. anybody with a driver’s licence. Many employers also have to have a first-aid training scheme with a specified number of employees who are trained regularly in first-aid procedures.

4. Different roles and responsibilities of staff working in emergency medical care

In Germany there are five types of rescue vehicles:

• The “Rettungswagen” (RTW) is used in case of accidents or an emergency. An RTW is staffed with at least one paramedic.
• The “Notdiensteinsatzfahrzeug” (NEF) is staffed with one paramedic and one emergency doctor. An NEF will go to the patient independently of other rescue vehicles.
• The “Notarztwagen” (NAW) is similar to an RTW but has an emergency doctor. NAWs are usually stationed at hospitals, so that doctors are readily available in case of emergency.
• The “Intensivtransportwagen” (ITW) has equipment similar to an intensive care unit at a hospital. It is used to transport patients requiring intensive care between medical institutions.
• The “Rettungshubschrauber” (RTH) (helicopter) moves emergency doctors independent of other emergency vehicles to sites where someone is in a life-threatening condition. The patient will then be taken to the nearest hospital with a helipad.

While NAWs, ITWs, and RTHs are usually managed by hospitals, RTWs and NEFs are usually provided by the “Bundesarbeitsgemeinschaft Erste Hilfe” (BAGEH), which includes different medical aid agencies, such as the Fire Brigades, “Arbeiter-Samariter-Bund e.V.”, “Deutsches Rotes Kreuz e.V.”, “Johanniter-Unfall-Hilfe e.V.”, or “Malteser Hilfsdienst e.V.”

In Germany patients in emergency situations are stabilized as much as possible in situ before being transported to hospital.

Germany does not train doctors in emergency medicine as a separate specialization. This means that emergency departments are usually run as a joint operation between specialists in different medical fields.

5. Cultural or religious issues

Patients’ rights are based on the 1981 Declaration of Lisbon, meaning that:

• everyone in Germany has the right to suitable and high-quality health care without regard to religion, nationality or other factors.
• every patient has the right to self-determination (see below for a definition of this in a medical context).
• patients have the right to claim confidentiality as regards information about their medical and physical condition.
• patients have the right to be fully informed about their health condition.

These are the tenets which underpin the professional work of health care professionals. Patients must be informed and give written consent for all medical interventions.

If the patient is not capable of expressing consent in a life-threatening situation, doctors may pursue the treatment that is in the best interest of the patient.

There are additional specific provisions for religious minorities such as Jehovah’s Witnesses.

Christian employers are allowed to prohibit healthcare professionals from wearing symbols of other religions such as headscarves. This does not apply to hospitals run by non-Christian organizations.

Jehovah’s Witnesses have the right of full confidentiality if they agree to organ transplantation. In recent years, sub-groups of Jehovah’s Witnesses like the “Association of Jehovah’s Witnesses for Reform on Blood” (AJWRB) have allowed transfusion of non-cellular blood components (e.g. coagulants).

Based on the concept of self-determination, patients are entitled to refuse certain treatments such as transfusions and/or organ transplants by oral agreement or with documents such as patient directives, organ donor cards or a medical power of attorney. In such cases doctors are then obliged to act in accordance with the patient’s will without risk of prosecution (i.e. for failure to give assistance).

If parents refuse treatments of vital importance on behalf of their under-aged children, doctors may refer the matter to a custody court, if there is evidence of endangerment to the welfare of the child.

Religious concerns regarding medical treatment and care also have to be taken into account. Muslim women might, for instance, request that they are treated by female medical staff or ask for a female staff member to be present if they are going to be examined by a male doctor.

6. Form of Address

In Germany it is usual for doctors to address patients formally ie. Mr/Mrs + family name. The use of titles is common in medical situations both for patients and doctors.

7. References

- Deutsche Bundesärztekammer