Living Abroad: Doctor visits, insurance, prescriptions, and what’s wrong with the health care system

When we told German friends and family that we would move to the US, some first reactions included, “The US? But their healthcare is so bad, and it’s expensive to be sick”! Back then, I wouldn’t know how to respond to that. How bad could it be, I thought. Also, let’s face it: Germans will always find something to mock about—at least when they don’t achieve or earn it themselves—and they grow up with the mindset that the German social security system is the golden standard.

And there is a truth in that: The elaborate social security system makes German citizens live comfortably even when they’re sick, disabled, unemployed, or retired, with health insurance cover being a legal requirement in Germany. It’s the principle of solidarity: Everyone has an equal right to medical care. To ensure that, all workers contribute about 7.5 percent of their salary into the public health insurance pool. In other words, as a worker, the greater your salary, the more you pay into the same healthcare system. Unless you earn enough money or are for any other reason entitled to private health insurance (eg, self-employed, state workers, only to name a few).

There is one downside to the nonetheless very social system: The all for one and one for all approach only works as long as the country is covered with enough doctors and hospitals to treat all these “equal” people. If that’s not the case, one still has the same access as everyone else, which means: waiting time. Particularly for specialists. I remember very well when I once was referred to an internist to perform a gastroscopy for an acute infection. The earliest appointment for the procedure that was offered to me was eight months later, which is ridiculous thinking of it. By the time the procedure had taken place, I would have been dead (if it was that acute in the first place). However, when I mentioned my private health insurance, I was offered an appointment on the following day at 8 am. So much to the equality and greatness of German healthcare. Yes, everyone is covered and pays into the system, but beneath the surface, it’s not all that fair and equal anymore.

When we moved to Singapore, I tried to avoid going to the doctor entirely for a long time, just because I had found my squad of doctors in Germany at this point in my life. And with us going back to Berlin regularly while blessed with international private health insurance, I simply planned to take advantage of the German system that I was so used to. Well, when the pandemic hit, that didn’t work out anymore. I remember I was afraid for a while about what would happen if we fell sick or needed a prescription since I frankly hadn’t a clue about the Singapore healthcare system.

Eventually, we had to stay for almost two years in the city, so, evidently, we had to go to a doctor at one point. And I have to say, I was impressed. Singapore was treating us very well (in that matter, anyway…). Granted, I was privately insured, but friends and colleagues reassured me that the general public system is equally good. What makes the system so outstanding, you may ask? Well, there are, first of all, lots of specialists in Singapore with virtually no waiting time, neither for an appointment nor at the clinic. Furthermore, all doctor clinics are easily accessible, with most of them being located in nearby malls or hospitals. And it’s incredibly efficient: whenever you get a medicament prescription, you don’t have to run to the nearby pharmacy to present your prescription note, potentially get the drug ordered, and come back later to get it (as it is usual practice Germany). No, you will simply receive your bag filled with all your drugs and––provided you are privately insured––a bill to present to your insurance later for reimbursement of the costs you have to pay upfront. There is a reason why rich people get richer, as you most likely will earn points or miles on your $$$ spending on the drugs and the doctor’s appointment, which will later unlock business class flights or discounts at Shangri-La accommodation. I am not even kidding here. But back to the topic, Singapore healthcare is excellent, easy, accessible, and follows high standards.

Now that we live in the US and have seen two different health care systems, I was very open and curious to see how it works here. What could go wrong, I thought. After all, we do have health insurance (and a cashback credit card). Little did I know that health care in the US isn’t only less accessible (well, you might assume that) and so incredibly expensive that you want to avoid getting sick or seeing the doctor altogether. It is ridiculous. It’s also a gamble: You never whether and to what extent your insurance will cover your costs, if at all. You learn after your doctors’ visit and when they present you the bill. Then, if you get a prescription, you will be asked what pharmacy you want it to be sent to, which sounds convenient, and is, compared to Germany anyway, and provided your insurance will cover the costs no matter which pharmacy you go to. However, if you happen to go to the wrong pharmacy, that is not in your insurance network, you have to pay the total price. However, there is the option to get the prescription transferred to another local pharmacy. Still, you better know beforehand whether this pharmacy is either in your insurance network or offering the best price, and also to what extent you have to pay out of pocket. Per my understanding, you always have to pay a part, called “deductable”, similar to Germany, but it might range from a couple of dollars to three-figure numbers. 

To avoid that and bring the price down, there is a so-called “RX Voucher” website that you can use to find coupon codes to clip on your prescription in order to save money on that. Obviously, it’s again only valid for the local pharmacy that has your prescribed drug ordered, so if they don’t have a coupon, you have to get the prescription transferred to that pharmacy. It’s so confusing, complex, and ridiculous that you might wonder why even bother and claim it to the insurance, how much could a drug be? Well, I was faced with prices up to $1000 for a simple cream, and while there might be people being available to pay that out of pocket without knowing whether they get it reimbursed or not, I certainly can’t. If you use one of those RX vouchers, however, the prices will decrease significantly, but you also won’t be able to claim the costs to your insurance at all. So you basically have to gamble and calculate the risks of either it’s better to claim the prescription and end up paying $1000 out of pocket, or buying it without a claim for a fraction with never knowing if you would have gotten it reimbursed. If you are still with me, reading this, here’s my dearest respect. It’s insanely bothering, complex, and confusing. 

On the other hand, however, I have been told that when you are employed with a big company and they cover your healthcare, the insurance might be insanely good. In that case, you might not have to pay out of pocket for either doctor’s appointments or prescriptions, and you most likely will not get denied when you have pre-existing conditions. One of our American friends that we met in Singapore even told me she preferred her American insurance over the Singapore one, which –at this point– for me, is very hard to believe. It is, after all, a very individualist society here, though, no “one for all” but rather a “one for myself”, which I get, to some extent anyway. People pay up to $1000 for their hair salon visit; why not for a drug that they have been prescribed and that they need? Where is our expectation that the insurance will cover it coming from anyway? Shouldn’t health be more important than beauty, and shouldn’t I be willing to spend a couple of hundred for my health if I am willing to pay the same for my appearance? Obviously, this goes only so far, as drugs are the one thing, but MRI scans are the other. I don’t even want to think of the costs and the pain that would happen if we needed that. But still, some part of me thinks that not everything the system here is like is terrible. It does seem fair to some point. God bless those who need insurance or are not wealthy, though.