This country of broad variations in its geography and its culture is one that has endured a long and troubled history, often as the battlefield for the great conflicts which have embroiled the European continent. It was not until the mid-19th century that what is now Germany became a federation; until that time, it had been a conglomeration of independent states. The empire was formed in 1871 after Prussia’s victory over France, and a period of prosperity and expansion began. Bowed by the outcome of the First World War and the subsequent economic and political chaos, Germany rose again as the Third Reich, but was finally defeated in 1945 by Allied powers and divided after the war. In 1990, after a peaceful and democratic revolution by its people, East Germany abolished the restrictive communist government and was reunited with West Germany (Wiedervereinigung). As a democratic republic, Germany has rebuilt itself into an important and influential state.
Population: 82.2 Million
Live births per year: 737,575
Life expectancy at birth: 83.1 years (girls), 78.2 years (boys)
Percentage of population under 15 years: 13%
Ethnicity: Mostly German, 17.1 Million Germans have a migration background (8.7 Million are foreign nationals)
Languages spoken: German
Type: Universal Mandatory health care system with two main types of health insurance; statutory insurance (Gesetzliche Krankenkasse), which insures most people and private insurance (Private Krankenkasse, about 10.5% of insured), which is accessible for people with a certain minimum income and those who are self-employed.
Germany has one of the oldest national social health insurance systems in the world, dating back to 1883.
There are public (majority) and privately owned hospitals, which provide services to all insured. Outpatient services are predominantly provided by physicians in private practice.
Cost to patient to see a primary care doctor / general practitioner: Covered by health insurance, therefore difficult to quote an exact figure. Minimum fees for complete physical exam and brief discussion of findings are about 20 Euros (ca. 22 US Dollars). This basic fee can be increased for time consuming cases. Generally, private insurances pay 2-3x the basic fee.
Cost to patient of squint surgery under general anesthesia: Outpatient surgery costs are approximately 1000 Euros & are more expensive if the patient stays in the hospital (1-2 days).
Number of Paediatric ophthalmologists: Because there is no formal fellowship for strabismus or paediatric ophthalmology in Germany, there is no precise number. Traditionally, strabismology is covered by neuroophthalmologists, and the German “Bielschowsky Gesellschaft” is the professional home for neuroophthalmologists and strabismologists. Increasingly, there are ophthalmologists who actually specialize in paediatric ophthalmology.
Major successes encountered in Paediatric Ophthalmology practice
Germany has a long history of outstanding ophthalmologists including Albrecht von Graefe (1828-1870, founder of modern ophthalmology), Julius Hirschberg (1843-1925, “Hirschberg test”), Alfred Bielschowsky (1871-1940, pioneer in strabismology), Anton Elschnig (1863-1939, “Elschnig pearls”), Karl Theodor Axenfeld (1867-1930, “Axenfeld-Rieger syndrome), Curt Cüppers (1910-1995, described the “Fadenoperation”) to name but a few. Orthoptists are very well trained and cover most of paediatric ophthalmology; many are employed in private practice, others in hospitals.
Major challenges faced in Paediatric Ophthalmology practice
Many ophthalmologists feel that they are inadequately trained in paediatric ophthalmology and strabismus. Formal fellowship training is not available in Germany (this applies to all subspecialties of ophthalmology), although there is an initiative to introduce it.
The income of paediatric ophthalmologists and strabismologists is lower than that of anterior segment surgeons, so that talented young physicians often do not choose paediatric ophthalmology / strabismus.