Medical check-ups

What is paid by the health insurance?

As the saying goes – prevention is better than cure. This is primarily for our health, which is our most important asset. However, the unfortunate reality is that not everybody makes use of health insurance schemes, which cover a number of check-ups.

Let’s look back at history as health insurance wasn’t always guaranteed. You’re born on the 15th of June 1883. The law concerning health insurance for workers was passed under former Imperial Chancellor Otto von Bismarck. In 1911, the National Insurance Act was created to protect employees.

The first social insurance on a national scale

The membership basis then expanded. Germany was the first country to introduce social insurance on a national scale. Austria followed the German model on 30th March 1888 by passing its own health insurance act, followed by Hungary on 9th April 1891.

Statutory health insurance is one of the few institutions from the Wilhelmini era that survived the turmoils of history and war, and is still used to this day. It forms a central pillar of the German healthcare system and is the oldest sector of social insurance.

Statutory health insurance was expanded into a comprehensive social security system and is constantly adapted to meet the respective challenges of its time. Together with pension, unemployment, accident and nursing care insurance, it makes up the German social security system.

88 percent of the population have compulsory insurance

When statutory health insurance (GKV) was first introduced, only 10 percent of the population had compulsory insurance. Today, around 88 percent of the population is covered under the government health insurance scheme. Today, it offers protection and comprehensive medical cover for around 73 million insured persons. Around nine million further citizens are members of private health insurance schemes. The remaining citizens are insured under special types of cover such as medical care by German Armed Forces.

Even though statutory health insurance is often referred to in singular form, it is not a single block. It comprises a large number of independent health insurance companies, each with their own scheme that citizens can choose and transfer between.

Pursuant to Section 173 of the German Social Security Code (SGB), insured individuals can freely choose between a local health insurance, a locally independent supplementary insurance and a company or guild health insurance if the individual is employed by a corresponding company or the health insurance is generally available to all insured individuals. The services of statutory health insurance in Germany are specified in the fifth book of the German Social Code and are rendered by the health insurance companies in accordance with the principle of benefits in kind.

Preventative initiatives by health insurance companies

As previously mentioned, health insurance services are continuously adapted to the latest medical and research findings. A major issue today is prevention, i.e. the early detection of potential illnesses.

Screening tests and vaccinations are still not fully utilised in Germany according to the National Association of Statutory Health Insurance Physicians (KBV). In 2010, the KBV and doctors’ associations thus launched a screening initiative to increase health awareness among the general population.

All members of a statutory health insurance scheme can access a range of check-ups and screening services. The aim is to detect illnesses and risks early on to prevent symptoms from arising. The general principle is as follows: “Prevention means preventing or screening illnesses and taking specific measures to prevent or at least delay an illness and its associated complications.”

Early detection means preempting an illness

Many people ask themselves why they should undergo a check-up if they feel fine. However, many illnesses are gradual and initially imperceptible. By the time you notice them, it can already be too late. Men in particular are less likely to undergo regular check-ups. Many only visit the doctor when they are ill according to a survey by the GfK. We will be discussing this in a future article on men’s health. Many people are also unaware of which free screening measures are offered by their health insurance scheme.


The 35 check-up

From the age of 35  – check-up every three years: From the age of 35 the check-up can be carried out by your family doctor. This check-up is only free once between the age of 18 and 35. Many private health insurance companies also cover the costs for these preventative measures, with the services comprising: early screening of cardiovascular disorders and diabetes. Anamnesis (patient’s medical history) physical checkup, checking lipid levels and blood sugar levels, checking urine, and consultation upon test results. Over the age of 35, screening for skin cancer is covered and can be performed every two years. This involves checking all of your skin.


Preventive medical check-ups for women

These serve to screen for common illnesses that can be easily treated. However, they must be detected in good time. Most of these illnesses typically occur in the latter half of life. From the age of 20, women can undergo screening to detect cervical cancer and other cancers of the genitalia: These include anamnesis (patient’s medical history) and an annual smear test for women aged 20 to 34 years to check for any cell changes – also known as a pap smear. From the age of 35 (every three years): Pap smear combined with a test for Human Papilloma Virus (HPV) and consultation on the test results.

Cancer screening

According to the World Health Organization (WHO), 19.3 million people were diagnosed with cancer in 2020. Breast cancer was responsible for around twelve percent of all new cancer diagnoses. With over 70,000 new cases annually, breast cancer is by far the most common form of cancer for women in Germany. Each year, over 17,850 women die of this condition. Furthermore, 6,500 in situ carcinomas appear each year (preliminary stage of breast cancer).

As a result, women aged over 30 can visit their doctor for an annual breast cancer screening. This involves scanning the breast and surrounding lymph nodes (armpits) and providing guidance on self-examination of the breast. If breast cancer is suspected, an X-ray of the breast (mammography) is carried out along with an ultrasound (sonography). For many women, tumours are only diagnosed during the screening.

The risk of developing breast cancer is not the same during each phase of life: The older the woman, the higher their risk of developing breast cancer: at the age of 35, one in 110 women will develop cancer within the next ten years. At 45 it is one in 48, and at 55 one in 37 women will be diagnosed within the next ten years, according to the cancer information service. Our advice: it’s best to go for a checkup twice a year rather than just once.

Breast cancer screening over 50 women are invited to attend a mammography screening every two years until they reach 71. They will be reminded to attend screenings by post to avoid appointments being missed. Bowel cancer screening is also offered over the age of 50 with advice on bowel cancer screening programmes. From 50 to 54, a yearly test for non-visible (occult) blood in the stool is offered. From the age of 55, everyone is offered a test for non-visible (occult) blood in the stool every two years or two colonoscopies at least ten years apart.

All adults with statutory health insurance can visit a dentist every 6 months free of charge for a checkup. Dental clearance (tooth cleaning) once a year and the creation of a Parodontale Screening Index (PSI) every two years are reimbursable. Children and teenagers up to 18 years must have their teeth checked twice a year.

Vaccinations for women

Over the age of 18, a combined vaccination against tetanus, diphtheria and whooping cough (pertussis) should be given every ten years. Anyone born before 1970 should have a booster as it is unknown whether they were vaccinated against measles, mumps, and rubella during childhood. An annual flu jab is also recommended. These recommendations by the Robert Koch Institute apply to women provided they do not have any pre-existing conditions (e.g. asthma, chronic obstructive pulmonary disease, heart disease, diabetes). Remember: all of these screenings and vaccinations are covered by health insurance companies in Germany and are free of charge for you.

Screenings for children and young people

Children and young people also have access to screening services. Any child with statutory insurance is currently entitled to eleven medical checkups. The first ten take place during infancy and childhood, immediately after birth until the age of 6.

Furthermore, young people aged 12 to 14 are entitled to a youth medical checkup. This provides an opportunity to detect and take precautions against any risk factors early on. Detailed information can be found in the yellow “paediatric examination booklet” that you will have received from the maternity clinic or your doctor, which documents any examinations.

The medical check-ups are designed to detect any potential developmental delays and illnesses in your child early on. Your doctor will also advise you on how to promote the development and health of your child and avoid risks. The focus here is on topics such as nutrition, exercise, avoiding accidents, and even media consumption. You will receive information from your doctor about regional support services, such as parent and child services or family midwives.

Also important to know: the doctor has a medical obligation to confidentiality – even for children under 18. If younger patients wish to keep the nature of their discussion private, the doctor must respect this unless the young person’s life is in danger.

Once again: prevention is better than cure

Stay healthy!

Sebastian Kneipp
Grippewelle_Immunabwehr stärken
Nachhaltiger Neujahrsvorsatz 2023