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HEALTH

EXPLAINED: How dental care works in Germany

It’s well known that a visit to the dentist isn’t a highlight of most people’s calendar. Nonetheless, making sure you know the rules around dental care in Germany can save you a lot of money and stress.

EXPLAINED: How dental care works in Germany
Photo: DPA

The first things you should know about dental care is that Germans have great teeth. According to a recent international comparison, only the Danes have shinier, whiter gnashers.

That great score is due to the fact that dental hygiene is a top priority here. Foreigners who visit a German dentist's practise are often pleasantly surprised by the thoroughness of the care and the modern equipment being used.

These things come at a cost though. The down side is that statutory health insurers are careful about what they pay for. 

That makes it all the more important to know what your rights are and how you can make sure you are getting the best deal.

1) Best in class

A 2016 comparison of dental care in different countries in Europe put Germany on top.

“The outstanding oral health of the German population, which has been established in various studies, has now been put into the context of the health care system,”  stated Dr Peter Engel, President of the German Dental Association at the time.

“The majority of the population is statutorily insured. This creates a system that is well equipped to manage crises and has an innovative and investment-friendly foundation, thereby assuring secure and modern dental care for the general public,” he added.

2) How do dentists in Germany work?

Back in the day, dentistry was a lonely business. After a Zahnarzt had qualified from medical school he would set up his own practise as a self-employed businessman. At best he might have gone into partnership with another dentist.

But things have been changing in recent years. A 2007 law allowed for dentists to start employing one another, leading to practises with several dentists working together.

Of the 100,000 dentists licenced to work in Germany today, only around half have their own practises. A lot of this change has been driven by female dentists moving into this once male-dominated world.

Some dentists even let you take your pet in with you. Photo: DPA

Many female dentists like the flexibility offered by being employed in a practise, as it allows them to combine work and family more easily.

While this is all interesting general knowledge in itself – who wouldn't want to know that there are 50,000 niedergelassene Zahnärzte (practicing dentists) operating nationwide? – it is also relevant to know how to find the right dentist for you.

Each dentist's practise will have its own style – and its own prices. So its worth visiting a few in your area to get a feel for their work culture.

Also – talk to German friends! Everyone will have an experience (positive or negative) that they'll want to share.

3) Check ups

Generally, health insurers will pay for a regular check up every six months, plus a yearly removal of dental calculus from your teeth. 

Getting your teeth checked at least once a year has knock on benefits, too. If you can show that you have had a check up five years in a row, your health insurer will increase its contribution to a tooth replacement from 50 percent to 60 percent. 

If you’ve been really well behaved and haven’t missed a dental appointment for ten years, your insurer has to raise its contribution to 65 percent. 

Critical here is that you record the visits yourself in a so-called Bonusheft (bonus booklet).

The dentist does not inform your health insurer that you've paid them a visit. So if you need a replacement tooth, you will have to provide the documentation yourself that proves that you regularly visited your Zahnarzt.

READ ALSO: Everything that changes in Germany in October 2020

4) Professional cleaning

If you want a full and thorough professional tooth cleaning (and believe us, they can be very thorough – and somewhat bloody) you will probably have to pay for this yourself, with the costs coming in at around €80. 

Most of the major health insurers do not pay this procedure, encouraging you instead to take out an extra dental insurance.

5) What about fillings?

If you need a filling, your health insurance has to pay for you to receive the most basic kind of material for filling up a cavity. If you need work done on your molars, health insurers will pay for you to get a copper amalgam filling.

They are obliged to do a bit more though for your front teeth, where you are covered to get a synthetic filling that has the same colour as your little biters.

If you want a more expensive form if filling, you need to talk to your health insurer about what they cover. Generally they should pay the cost up to what the more basic option would cost.

Photo: DPA

6) Gum disease

If your dentist thinks that there are good medical reasons for you to have an operation due to gum disease, your Krankenkasse (health insurance) will cover the costs.

It’s important though to consult your dentist on a plan that covers both the costs and the healing process. You need to send this plan onto your health insurer, who will then green light it if it meets the legal requirements. 

With some health insurers, which as TK, the dentist will directly send the plan to the insurer. So it’s advisable to ask your insurer what steps you need to take first.

Its pretty common that a dentist will try and upsell you on extra services such as a professional tooth cleaning. But be careful! Your insurer is unlikely to cover the costs here.

7) Pulling and replacing teeth

Got a rotten tooth at the back of your mouth that needs to be pulled, but you're scared of the costs? Fear not, your health insurer is obliged to come to your aid.

They are also legally required to cover half of the costs of a replacement tooth. But, again, this is only for a basic metal replacement in your molar area and a synthetic tooth in the front of your mouth. If you want a slightly better looking replacement, they should still pay a portion of the costs, though.

Also, if you are on welfare or earn less than €1,190 a month, you are considered as someone who needs support which means your insurer will cover 100 percent of the cost of a new tooth.

8) What care do children get?

Good news on the kiddie front. Young children up to the age of six are entitled to three free check ups, each of them at least a year apart. From the age of six to 18 they can have two check ups a year. And kids who are at risk of developing cavities can also receive free treatment with fluoride varnish twice a year.

There is also good news if your teenager has wonky fangs. Statutory health insurers have to pay 80 percent of the costs of orthodontic treatment for your first child and 90 percent for every subsequent sibling.

9) How to save cash

As we said above, it is important to understand that you are not obliged to stick to one specific dentist. Dentists are self-employed, which means that you can shop around and pick the one who you feel will offer the best prices for the service they are offering.

There are several online portals, eg zahngebot.de that allow you to compare prices. You can then visit a dentist in person to see whether you want to undergo treatment with them.

If you have a favourite dentist, the national consumer rights group Verbracuherzentrale recommends getting a few quotes elsewhere and then confronting him or her with a cheaper offer. Apparently many are willing to negotiate.

Another option is getting the treatment at a hospital from a trainee dentist. This is much cheaper, although it takes longer as it is done under the watchful eye of a qualified tooth doctor.

READ ALSO: Health care – everything that changes for patients in 2020

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JOHN LICHFIELD

ANALYSIS: How sick is the French health system?

Amid warnings that parts of the French health system are on the verge of collapse and a new government plan for health reform, John Lichfield takes a look at exactly what - if anything - is wrong with healthcare in France.

ANALYSIS: How sick is the French health system?

Within 10 kilometres of my home in deepest, rural Normandy I have access to six doctors, a dozen nurses and a medical centre.

Two of the small towns within 30 kilometres have full-service hospitals. A little further away in Caen, there is one of the biggest and best hospitals in France.

Maybe I’m lucky. In the next département to the south, Orne, there are large areas where there are no doctors  at all – “medical deserts” as the French call them. One in ten French people has no GP or médecin traitant. Over 600,000 French people with chronic illnesses have no doctor.

Twenty years ago, the World Health Organisation declared the French health system to be the best in the world. In more recent surveys, France often comes in the top ten and sometimes in the top five.

You can hear John talking healthcare with the team at The Local in the latest episode of the Talking France podcast – download HERE or listen on the link below

And yet the French public hospital system is, we are told, close to collapse, exhausted by Covid and years of under-investment. Some GPs are threatening to go on strike for a doubling of their official fee of €25 for a consultation (less, as they point out, than you pay for a hair-cut or a manicure).

President Emmanuel Macron and his health minister, François Braun, agree that there is a problem. Macron is a doctor’s son. Braun is a doctor. They have diagnosed a number of problems; partly a shortage of money at the point where it is needed, partly chronic disorganisation and poor administration.

French health minister: We must reform the health system to reflect the France of today

President Macron, in his New Year message to health workers last month, promised that all the 600,000 sick people without a doctor would be offered one before the end of the year. He promised that there would be 10,000 “medical assistants” instead of 4,000 by the end of 2024.

He also promised an end to what he called the “hyper-rigidity” in the system of financing, administering and staffing of hospitals. (In other words, he gave no promise of extra money but the government has already committed to spending an additional €19 billion on hospitals over ten years.)

This is not just a French problem, as anyone who follows the news in Britain will know. All health systems in the world are struggling to cope with ageing populations, expensive advances in medical treatment and restraints on public spending.

The French health service is, overall, less impressive than it was 23 years ago when the WHO declared it to be the world’s finest. The same is probably true of all of the others.

The explanation for the French decline is partly universal and partly French; partly about money and partly about French politics, French attitudes and even French geography.

More than prescriptions: 10 things you can do at a French pharmacy

In purely financial terms, France  spends a huge amount of money on  health. Overall, the country invests 12.4 percent of its annual GDP on health care (mostly channelled through the state). This compares to 12.8 percent in Germany, 11.9 percent in the UK and 17.8 percent in the United States (much of it private).

In both GDP terms and cash terms, the amount has been rising despite the fact that investment in public hospitals was severely restrained for 15 years by Presidents Chirac, Sarkozy and Hollande. In terms of health outcomes France, according to the OECD, remains the second best-performing country in the world, just behind Japan.

And yet there is something odd and unbalanced about how France spends money on health – an imbalance which has become more problematic as cash become scarcer.

Although France spends almost as much overall as Germany, it has fewer doctors and nurses and pays them far less. It has fewer hospital beds than Germany but many more hospitals.

The share of French health spending which goes on administration is 7 percent, compared to 5.5 percent in Germany.

The proliferation of hospitals is one explanation for this high admin burden. France has 4.42 hospitals for every 100,000 people, compared to 3.62 in Germany and 2.86 in the UK.

It should be remembered, however, that the number of hospitals is partly imposed by the fact that France is a comparatively large, empty country. Medium-size towns have their own hospital because it is a long drive by ambulance to a big city. Closing down rural hospitals would – rightly – provoke an outcry.

Even more striking – and less justified – is the French addiction to drugs and pharmacies. My neighbouring small towns in Normandy have two or three pharmacies each; almost every large street in Paris has at least one. It is scarcely surprising that medicines, and their distribution, account for 18 percent of all health spending in France, compared to 15 percent in Germany.

READ ALSO Why do the French love medication so much?

Another ‘French’ factor which has put enormous pressure on the French health service in the last two decades has been the 35-hour working week. Its effects on industry and office working have sometimes been benign; in the staffing of hospitals, it has been a calamity.

Macron in his New Year health address identified the application of the 35-hour week as one of the areas of “hyper-rigidity” in the administration of hospitals that he wanted to change this year. He has been accused of wanting to abolish the 35-hour week in the health service. That is not quite what he said.

As the more reasonable medical commentators’ admit, Macron (the doctor’s son) has done more for the French health service than his predecessors. Apart from the €19bn for hospitals, he has spent an extra €12bn on pushing up doctors’ and nurses’ incomes (which remain lower than they should be).

He also removed the absurd cap on the number of doctors which French medical schools were allowed to produce each year.

Macron is asking for trouble if he thinks he can resolve the present crisis without spending more money. But it is wrong to suggest, as some do, that France has the worst of all possible health services. 

The debate on the  French health service suffers from the same crippling ailment which afflicts other areas of political life in France: a catastrophism which ignores what is going well and fails to identify what needs to be changed.

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