A note from Pie Face: I am admittedly and unreservedly biased toward the German system of universal healthcare. You can read more about it here, but in sum it is a mixture of state regulated nonprofit health insurance organizations, or “social” care, and private insurers. Healthcare providers are mostly private. German healthcare is cheap, fast (faster than here, usually) and of excellent quality. Maple Pie describes below what it’s like to navigate the German system as a cancer patient, including pre- and post- operative care.
By Maple Pie
I have two insurance policies for medical and dental care. The “obligatory” one is from a public health insurance company of my choice and gives me standard universal coverage for an income-based monthly fee. The optional one is from a private health insurance company, a so-called supplementary policy which covers me for semi-private stationary hospital treatment, i.e. a two-bed room and treatment by the head doctor or his authorised substitute. I can have a one-bed room if I pay the extra cost from my own pocket.
When a standard screening for bowel cancer turned up positive, my family doctor gave me an acute referral for a proctologist. The enteroscopy, given under sedation, confirmed there was a malignant tumour that needed to be removed in a hospital. The necessary referrals in hand, I went home and laid down for the rest of the afternoon while my husband phoned around for advice. It turned out an acquaintance was Head Visceral Surgeon and a Professor at a nearby University Teaching Hospital!
I was in hospital for further diagnostic work within about 10 days. The results were discussed in a conference of doctors from all relevant disciplines, which set up the roadmap for further treatment. A port was set just below my right shoulder to allow chemotherapy with a pump system (a very gentle method), a tumour marker was set and radiation appointments arranged.
A referral from a local oncologist entitled me to out-patient treatment in the hospital’s Oncology and Nuclear Medicine Departments. Regular blood work, medication, chemo, radiology and regular feedback from doctors were all taken care of in the hospital and registered in my “Therapy Pass”. A good prognosis , co-ordinated treatment, regular feedback and the luck to have read Randy Pausch’s “The Last Lecture” before my cancer was discovered provided me with a positive attitude.
The Operation took place 3 months after the original diagnosis. After 24 hours in intensive care I was back in my room. A specialist arrived to check the pain killer machine and a physiotherapist came with first exercises, e.g. how to get into a sitting position or to roll out of bed.
By the time I was released a good week later I had been set up with an ostomy therapist to help me handle my colostomy pouch independently and the hospital social worker had booked me for a post operative care measure in Bayrisch Gmein, a spa near Bad Reichenhall. This is a three-week rehab sponsored by a private cancer treatment initiative and must be begun within 14 days after hospital release. Without going into detail, it was fantastic; an individually tailored and co-ordinated programme for medication, diet, physio- and psychotherapy, further colostomy pouch training, and informative seminars on, for example, further relevant treatment and how to manage the paperwork involved. Free time was spent in the legendary spa, Bad Reichenhall, to which we had access.
Three months after the first operation the colostomy could be reversed. I had access to the proctology department and my ostomy therapist took care of the paperwork necessary to set me up with necessary hygiene and medical aids. The public health care policies cover the cost of pouches, lingerie protectors, etc. up to a certain level. Patients pay a small per cent of the cost of such articles and must cover “extras” themselves.
Every three months after the colostomy reversal I have been called into the Oncology Department for regular blood checks and occasional CTs, enteroscopies, chest X-rays, etc. The results are discussed with the oncologist who manages my case. This year I have graduated to a six-month rhythm. Throughout the treatment my family doctor and I have received relevant documentation of tests and medical reports for our records. All in all, my treatment has been competent and comprehensive, and I am more than satisfied with the results.