Difficulties accessing medical services as an EU immigrant in Germany

OK, first off: you definitely need some German speaking friend to deal with German bureaucracy. So ask around who can help you with going to the "Behörden" to deal with the problems of your friend.

If the sickness of your friend is an emergency, your doctors should accept the European card EHIC (if she does not have one, she should be able to get it from her Italian insurance). But this of course is not a permanent solution, so yes, your friend needs a German insurance. If this is not an emergency but also not resolved quickly, then she should really think about returning to Italy for treatment, as the costs can escalate pretty quickly; not only doctors but especially pharmaceutical drugs can be very expensive in Germany.

If your friend wants to live in Germany, then yes: she needs to go to the "Einwohnermeldeamt" an register there. I know that this does feel weird for people who are not used to this, but it's usually a pretty easy process and done quickly. The only thing you need for this is a permanent residence in Germany, so some kind written of rental agreement ("Mietvertrag") is necessary. As for private/public insurance: avoid the private ones if possible. However, if she was privately insured in Italy, she definitely cannot enter the public one in Germany, so private is the only option then. If she has Italian public insurance: To enter German public insurance, you do not need to have a job, but you need to actively search for one. So she will have to go to the "Arbeitsagentur" and register there as searching for a job. She'll definitely need some German speaking fellow to help her with this, otherwise it will take far longer. I think it is also possible to remain in Italian public insurance and "enhance" the EHIC support so that it covers Germany, so you should investigate in that direction as well. Good luck and I hope your friend will get better soon.

I would also like to move to another country where I've contributed nothing, and then have taxpayers in that country give me free stuff. Maybe next time I need medical work done I can stop in the Italy, have the Italian taxpayer pay for it, then fly off to a country where I'd actually like to live (e.g. a country which cares more about consumers than the taxi mafia).

In all seriousness, the Indian medical system is a shining example of how to be functional. You show up, find out what needs to be done, ask the price, pay and it gets done. I've had LASIK and 2 spine surgeries done in India, +1 will return for all my future medical needs.

While I could possibly sympathize a bit with the parts of the post dealing the frustration of dealing with German bureaucracy, after having experienced the Italian health care (having experienced both personally), I don't understand the sense of privelage.

As a non-eu immigrant in Germany things are far worse and IMHO one just trades health care issues for other issues if one were to move the other way (Germany to Italy)... Or for that matter anywhere else in the world.

Seems like the apt scenario for the quote "When in Rome..."

The issue of how to fund welfare services, particularly health care, is basically the most difficult challenge faced by every government.

Health care budgets in most major countries seem to be growing faster than their ability to pay for them.

Naturally, every citizen and every immigrant feels like they should be able access whatever health care they need whenever they need it, particularly in an emergency.

And the notion that critical health care is a fundamental human right that should be provided to everyone is a reasonable one.

But it still doesn't address the question of how governments pay for all the staff and facilities and supplies that it takes to run a health system, particularly when so many western countries - Germany more so than any other - have just had a huge influx of people who need access to welfare services but aren't paying taxes to help fund it.

I don't have answers, I just know it's a hard problem and it's only getting harder.

But here's a suggestion: I think the post would be stronger if you were able to consider things from the point of view of the government who is faced with the challenge of providing and funding their health system, and of setting the right incentives for people to contribute their fair share of the costs and only use the services they really need.

I would really like to know what the exact problem is: I have been "freiwillig versichert" for years as a freelancer, no need to have an official employment.

I sort of agree with some of the commenters here - the system works as intended. If you move to any country without a job first you will have a hard time. Health insurance shouldn't be part of a free 'welcome package' to whoever just feels like dropping by.

However, I think it would be hugely beneficial when all (goverment sanctioned) EU health insurances would be valid in all EU countries. If you get a private insurance in Germany you usually have this already covered. But not with the state insurances, for whatever reason.

Having lived abroad for some time I can sympathize with the problems mindflayer and his girlfriend have. Health insurance is often a pain as a foreigner and immigrant, Germany doesn't seem to be an exception.

I looked a bit around and it seems that the OP didn't research all options (language barrier and bureaucracy is often a problem here).

@Mindflayer: I suggest you find an expert that can guide you through this jungle.

But what I found in my quick research is that there is a european health insurance card (apparently one can get it from one's EU health insurance in one's home country, it's called EHIC). It allows a German doctor to book services against your Italian health insurance. Unfortunately, it only covers emergencies.

For other medical services you are right, it's probably easiest if you have a job or are married. But it seems that there is another option: your girlfriend registers as unemployed/job seeking. Job seekers from EU countries are treated similarly as employees and hence are entitled to public health insurance.

Source: https://www.krankenkassen.de/meine-krankenkasse/krankenversi... (German)

Most of the comments are definitely out of topics. The European health insurance card only covers emergencies, and I've never said it was a problem. The problem was being able to investigate the problem because they only allowed her to access to some basic checkups like blood exams, that were not enough to solve her problem. Of course we have German speakers as friends but in this case it did not help. The biggest problem I see is the fact that Anmeldung and the health insurance subscription are totally disconnected, so you can have people with the right to live in Germany but actually without the possibility to access to the German healthcare system, that is again what I call a bug.

She's not registered, she doesn't have a job and never had one. In other words she's a tourist and is treated as such.

That's not a bug, that's a feature and the system working exactly as designed.

Not a direct response to the post. But if you have someone visiting you from another country, consider setting up an "incoming health insurance" for them. It's just a few bucks.

Whenever I have relatives coming to Germany from abroad, I will have this insurance ready for them.

Gotta follow the rules in Deutschland! Not so in Italy...

There are some details missing. I suspect that the woman moving to Germany effectively moved her out of the Italian health system. Different story if she was traveling to Germany - her Italian health insurance should have been portable then. Moving residence between countries without researching health insurance is not wise. German hospitals will still provide emergency care if needed in a life threatening emergency.

Yes, the German system is not so open. The author correctly describes two options semi-public/private both with entrance hurdles.

The private system are individual insurances. There may be deductibles but generally their coverage is very good. Doctors are paid often double the amount they get from public patients so are also very eager to get these patients. Your health risk here is over-treatment. Why is not everyone getting this fantastic deal? One has to earn a certain amount, be self employed or be a public servant with tenure. The cost depends on pre-existing conditions so unless you enter as healthy&young it becomes very expensive option.

The semi-public insurances are administered by a couple of companies all following the 98% the same rules, some dread disease pool payments between them forced by government to allow portability. Doctors are paid less but the majority of the patients are in this system so there are still penty. Getting a specialist is another topic - there are usually waiting times. The semi-public insurances compete on the 2% differentiation, marketing and their service. One typically enters the public system by not having a private insurance and getting a low paid job. There are other routes to entry but any path less trodden is harder to walk. Unlike the private system the public system covers family (partner if not working and dependent children up to a certain age). Payment depends on your salary up to a limit. In 2017 the MAXIMUM cost based on a rate of 15.7% of ones salary up to a max. salary of 4350€/month are: 317.5 employee and 317.5 employer = 635€/month. If you are earning half then it will be only half.

For anyone in the private insurance the path back to the public insurance is explicitly closed at a certain age. The German system differs from the US system in particular as there is no Medicare. Financing health care in retirement can be a problem for people as the cost in the private system goes up. The private insurances have to put money aside to compensate for health costs of their older customers but that only cushions it.

Health care is expensive and needs financing for dread diseases and high age. This hard fact is a limiting what is possible and requires boundaries to entry. One can not have people saving in one system for a long time and letting others into the same pool when they need access to that pile of money. Germany is able to sustain two systems due to the boundaries between them. The dual system was becoming unstable a few years back when the birth rate decline lead to more older people leaving the private system when older and going into the public one. They enjoyed better service and lower rate in the private system when their health became more costly relied to the wider population in the public system driving up costs there. That was seen as unfair and lead to a shoring up of the boundaries between the two systems.

Article aside - repeating (what feels like) every other sentence as big heading is incredibly annoying and makes it hard to focus on the content. Who thought that would be a good idea??