Germany Struggles With Healthcare Reform Side Effects

On Monday evening, the German public television broadcaster ARD aired a special report detailing the impact of Germany’s sweeping healthcare reforms on the disabled and chronically ill, specifically those on social assistance who live in assisted living facilities and homes.

At the heart of the report was the story of Helga Leonhard, a wheelchair-bound social welfare recipient who suffers from chronic pain and lives in a home in Bad Kreuznach, in the German state of North Rhine-Westphalia.

Under the new reforms, intended to cut costs in an already overburdened system, patients must pay a €10 co-pay for their first visit to the doctor each quarter, transportation to and from the hospital is no longer covered, and patients must foot the bill for some of their medications.

Leonhard, who must be transported via ambulance to the hospital for weekly pain treatments, now faces an additional €116 in health-related costs per month.

Considering that she only receives €112 in discretionary income a month from social assistance benefits, that’s simply too much. “How am I supposed to pay,” lamented Leonhard. Her doctors fear Leonhard and patients in similar situations – when faced with tough financial choices – will neglect their care.

Ulla Schmidt on the defensive

After airing the report on the evening news program “Tagesthemen,” an ARD anchor confronted German Health Minister Ulla Schmidt with Leonhard's case. Did this spell the end of the “solidarity principle,” which has so long underpinned the German healthcare system?

Schmidt defended the reforms, claiming that – on the whole – they have been a success. But the case of Leonhard and others demonstrated that some adjustments needed to be made, which she promised would be forthcoming in the next week.

“Those who are chronically ill or have paid for a medical transport, which they shouldn’t have, will be reimbursed,” she promised. Schmidt stated that no one should experience undue financial distress due to the difficulties associated with the introduction of the reforms.

However, in order to establish special rules for the “chronically ill,” a list must be established determining which illnesses will count as “chronic.” With the government, public insurance agencies and doctors failing to establish such a list before ushering in the reforms on Jan. 1, officials have a bit of catch-up work to do. Again, Schmidt promised this would also be resolved soon.

Ilka Sax Eckes, the government representative in charge of the affairs for people with disabilities in North Rhine-Westphalia, where Leonhard lives, said the situation was a temporary “transitional problem.” Handicapped persons won’t have to pay more than €71 per year, she claims, and special exceptions will be made to cover transportation costs for those incapable of getting to medical facilities on their own. Still, critics say that for some on social assistance, even that is too much.

Schmidt promises changes, CDU says 'not without us'

The questions that emerged in the report on Monday night over the plight of the handicapped and chronically ill are just the latest in a series of criticisms Germany’s health minister has faced since the start of the year.

Also part of the debate: what types of co-payments, if any, should be required for emergency medical attention and whether or not women should pay a co-payment when they visit their doctor for the sole purpose of getting a refill prescription for birth-control pills. Those decisions must all be made by the public health funds and doctors' associations. The government merely sets the framework, Schmidt said.

The health minister’s seeming willingness to debate some aspects of the healthcare reform package and, possibly, make changes, has worried some in the opposition Christian Democratic Party (CDU). In the German mass circulation Bild, Andreas Storm, a member of the CDU’s parliamentary faction, warned Schmidt against promising any changes without discussing them with the CDU first. Such a process could unravel the compromise reached by the CDU and governing coalition of Greens and Democrats, he said.

The package of reforms, which was approved by the German parliament in September, is aimed at reducing Germany's non-wage labor costs, which are thought to contribute to the weak economy, and cut €20 billion from the soaring health care costs.

In the meantime, patients like Leonhard continue to wait in the wings, worried about their future.