A cure abroad – and in the European Union – is possible in principle. More and more German health insurance companies have already concluded contracts with Eastern European spa hotels. Every fourth health insurance cure is already taken abroad – mainly because the prices are up to 70 percent lower than those of cures in Germany. Cures – or as it is called today rehabilitation, prevention and health promotion – are even regulated by law in the Social Security Code. Cures are based on the principle of activating the body’s own healing powers. Contact No. 1 for the cure prescription is the attending physician, i.e. family doctor, specialist or also company doctor, who must certify the necessity of a cure measure to the health insurance company by form.
Saving costs in Karlsbad and Co.
The health insurance companies meanwhile also approve cures abroad. Some health insurers, above all the company health insurance funds (BKK), have concluded contracts with facilities in other EU countries, for example in Poland, the Czech Republic and Hungary. This has been possible since the Eastern European countries joined the EU on May 1, 2004. The contracts with Eastern European spas were concluded with the justification of having negotiated better discounts and special services. For all health insurance companies, the cost factor is the most important factor: cures are considerably cheaper in the Czech Republic than in Germany. One example: Karlovy Vary was founded around 1350 by the Roman emperor and Czech king Charles IV. The place became famous all over the world because of its warm healing springs. About a hundred of these springs rise here, and twelve are currently used for drinking cures. The spring water is especially beneficial for metabolic disorders. The cost of room and board is about 40 percent less than in German spas. And: Language problems are almost non-existent; German is spoken from the nurse to the head physician. That’s not surprising, since about a quarter of spa guests now come from Germany. The ARD program “Plusminus” from April 2005 reported that the savings potential abroad is huge, the quality is comparable and the experience is good. Up to 70 per cent cheaper are the cure applications in Tschechien or Poland in the comparison to German health resorts. With the competition from Eastern Europe, competition is taking on a new dimension and the first German spas are already feeling the effects.
More competition – and wellness
But competition also has its good side: German spas – 320 of them exist in this country – are focusing on quality – like Bad Elster and Bad Brambach: both spas are located right on the border with the Czech Republic and have the competition right in front of them. Their concept focuses on more quality and a “modern appearance”. Bad Brambach offers, among other things, a 21-day Gesund Premium cure, which is intended to meet demanding requirements – here the boundary between a classic cure and a wellness offer is fluid. With this form the bath physician arranges an individual cure program for the patient. In addition the patient profits still from additional offers such as Ayurveda, Massagen with hot stone and other Wellness offers. However, these treatments must be paid for privately
. The new quality seal of the German welfare bath federation Wellness in the health resort stands for a special health offer. That means: Places, which carry the seal, offer a pallet at medical applications, in addition, however, also newer Wellness offers. The ten quality requirements include holistic medical and therapeutic competence as well as state-recognized quality features such as a natural healing climate. Important are likewise good service and good cultural offer. According to statement of the welfare bath federation the concept is meant for interested, which want to do preventively something for their health. But: the costs must be paid out of pocket.
Outpatient and inpatient cures
In a cure, a distinction is made between an “outpatient preventive service” and the “inpatient preventive or rehabilitation service”. Together with the doctor, one chooses the suitable spa – even a place abroad. The physician informs in advance about the necessary forms of treatment at the health resort. The outpatient preventive cure is applied for at the health insurance company in cooperation with the doctor. After approval, it must be started within six months. The health insurance company subsidizes accommodation and meals up to 13 EURO per day (depending on the health insurance company). The costs of the spa doctor are covered in full, except for the practice fee.For therapeutic services, the prescription fee and a ten percent co-payment are added. Outpatient cures:
Outpatient cures may be approved at three-year intervals. Outpatient preventive care may be indicated if there are proven risk factors, if these can be eliminated or influenced by the measure, or if the patient can be helped to cope with these factors. Examples include obesity, hypertension, tendency to somatic diseases, and recurrent musculoskeletal pain conditions. In this case, the patient must request leave from the employer. Inpatient cures:
In the case of inpatient treatment in a preventive or rehabilitation facility, health insurance recommends an appropriate contract house. Inpatient cures are indicated, for example, when the ability to work is to be restored after surviving a serious illness – for example, after a heart attack. In this case, a cure means that the patient is still on sick leave and does not have to apply for a vacation. Repeat inpatient cures are usually approved after four years. However, there are also – depending on the course of the disease – medically indicated exceptions to falling below this interval. In the case of an inpatient cure, the patient must pay an additional 10 EURO per day. As with an outpatient cure in Germany, the health insurance fund covers the costs of medical care and treatments – and it settles directly with the facilities abroad. In 2004, around 30,000 cures in other European countries were paid for by health insurers. Measured against the approximately 118,000 outpatient preventive measures approved in Germany, the share of cures abroad is about one quarter. Incidentally, there are about 1,100 spas and health resorts in the EU, and about 190 in the new Eastern European member states.
Criticism of spa exports
The German Spas Association, however, criticizes the “spa export.” The funds would endanger the economic and service location Germany, it says in a press release of the association. “This would deprive German spas and health resorts, which meet high costly quality standards, of spa guests. The economic effects are already noticeable.” In the year 2004 a decrease of the ambulatory cures had to be accepted around 22,8 per cent. The association demands uniform quality standards for all of Europe. For the health insurance companies, however, what counts first are the costs, which in many Eastern European countries are considerably lower than in this country. For the patient in the long run counts whether quality and achievement correspond to the standards in German health resort hospitals. That applies in the medical-therapeutic range and with accommodation and food supply. Already before the medical attendance one should inform therefore about possible health resorts in European Union countries. In the application one can indicate only one desired health resort. The health insurance company only reimburses the costs of a cure abroad that it would also cover in Germany. Additional costs must be paid by the patient. Among the health insurance companies that were among the first to approve the foreign cure is the Hanseatische Ersatzkasse. According to the statement of the HEK the health resorts are quality-checked – the accommodation of the patients takes place e.g. in Marienbad in houses of the Danubius group. The experience so far has been positive. Indirectly, patients benefit from the stiffer competition from abroad, as the spas and health resorts in Germany respond with additional offers and high quality standards. Information about approved health resorts at Kurärztliche Verwaltungsstelle 44141 Dortmund, Westfalendamm 67 Tel.0231-94117920.
