Germany's controversial new consultation fees
What can you get these days for € 10? A ticket for the cinema and a small packet of Gummibärchen; coffee and cake for two; and, since January 1, a visit to the doctor. Yes, for those of you who have been too healthy—or too scared—to go to your physician in 2004 the much-debated consultation fee (Praxisgebühr) was introduced at the beginning of this year, just one of many measures intended to help fill the empty coffers of Germany’s health insurance companies. The consultation fee, however, applies only to certain patients, i.e. those who are insured through an insurance scheme such as the Barmer, AOK, KKH, Techniker—anyone who is privately insured will not need to pay—and only under certain conditions. When you visit your local GP (Hausarzt) for the first time in a new quarter (Quartal), you will be asked to pay the € 10. If your GP then refers you to a specialist (Facharzt), you will not have to pay a further fee unless your visit to the specialist falls within the next quarter. There are plans to change this ruling and allow referrals (Überweisungen) to be free even if they are not within the same quarter. Consultations made by your GP on the telephone (Telefonberatung) also cost € 10. If you go directly to a specialist you will be asked to pay the consultation fee. The same applies for emergencies (Notfälle). On admission to the emergency rooms (Notaufnahme) of a hospital or clinic you will need to pay either on the spot or later by bank transfer (Überweisung). This applies to both “out-patient treatment” (ambulante Behandlung), where the patient is not required to stay in hospital over night, and to longer stays in hospital (stationäre Behandlung). The only exception to this rule is when a patient needs treatment in hospital over a weekend because their own doctor is not on duty. This would apply to the changing of bandages (Verbandswechsel) and so on. Anyone visiting the doctor for a preventative check up (Vorsorgeuntersuchung) will not need to pay the consultation fee and this applies to check-ups at the dentist too—otherwise visits to the dentist that fall within a new quarter, say, for treatment of a cavity or infection, also costs € 10. Those suffering from chronic illness (chronische Krankheiten) will have to pay the consultation fee once every quarter. Visits to the doctor for repeat prescription of the pill are free. Unfortunately, the consultation fee is probably the simplest of the changes that have been implemented as part of the health reform. Patients insured through the major health insurers now have to pay 10 percent of the price on prescription-only medication (verschreibungspflichtige Arzneimittel). The minimum surcharge is € 5 and the maximum € 10 per medication. There is also a 10 percent charge for patients receiving massage and fango treatments. And anyone who faces a longer stay in hospital can expect to pay € 10 a day, though this applies only to stays of 28 days and less. Children up to the age of 18 are not affected by these new charges. And, last but not least, remember to keep the receipts of any of these fees (Zuzahlungsbelege). Once your payments add up to more than the amount the health insurance companies calculate to be your annual financial limit (Belastungsgrenze)—this varies from person to person, depending on your income—the aforementioned charges no longer apply. Certain insurance schemes, such as the Barmer, give patients a so-called Befreiungskarte, a card that can be shown at subsequent visits to the doctor, so that no more costs are incurred. We would like to thank the Barmer Ersatzkasse for their help in compiling this text.