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The German doctor Dr. Peter Niemann, was pretty astonished when he found out, that a minor medical intervention in the USA costs up to 2,000 dollars.

Germany does not only have one of the most advanced healthcare systems in the world, it is also comparatively inexpensive. This has been made clear in an experience report by the German doctor Dr. Peter Niemann. Dr. Niemann works in the USA and regularly blogs for the Deutsche Ärzteblatt, the highest-circulation specialist journal for doctors in Germany. In a blog post, he explains how billing works in the USA. There is the so-called “Relative Value Unit”, which determines the costs for medical services. A Relative Value Unit (RVU) is then multiplied by a certain dollar value, in order to determine the minimum costs for a medical intervention. This dollar value is defined by the state-run Medicare and Medicaid health insurance programs. In 2017, this value was at 36 dollars.

Treatment costs for a small intervention in the U.S.A.

If a patient suffers from shortness of breath, the doctor can help with a simple and quick method which already exists since the Middle Ages. For the so-called pleural puncture a needle is introduced into the space between the costal pleura and the pulmonary pleura after a local anesthetic in order to remove fluid. This intervention can be performed on an outpatient basis, Dr. Peter Niemann needs 20 minutes for this.

In the USA, a pleural puncture is estimated with a RVU-value of 2.27. If you multiply the RVU-factor with the value of 36 dollars, this results in costs amounting to 82 dollars. However, this is just the expense for the treatment. In fact, the practice or the clinic adds fees for material, laboratory and medication etc. so that costs can increase to 400 dollars. And even this is just a minimum amount. In a personal meeting with Dr. Niemann, we found out that his patients pay more than 1,000 dollars, sometimes even 2,000 dollars, for this simple intervention.

Pleural puncture in Germany

If you would have a pleural puncture performed as a foreign patient, the German doctor would have to bill the service according to the German Scale of Medical fees (Gebührenordnung für Ärzte, GOÄ). This scale of fees is a constitutionally binding catalogue which all doctors in Germany have to adhere to. Private patients in Germany are also charged according to the German Scale of Medical fees.

If you look up the costs of an outpatient pleural puncture in the scale of fees, depending on the complexity, the price will range between 14.57 euros and 33.51 euros. Thus, this intervention is twice as expensive in the U.S.A. only given the scale of fees. But Dr. Niemann wrote about further costs. What is the situation in Germany?

Indeed, the doctor in Germany also charges additional fees. Let’s stick with the example of the pleural puncture. For arranging the appointment by phone, the doctor can claim a maximum of 3.15 euros. For a treatment in the practice, another 21.46 can be added. An extensive consultation in the practice can be charged with 20.10 euros. Also, the material costs have to be paid by the patient. Usually, the doctor uses a pleural puncture set which costs 13.77 euros per unit. Additional material such as a sterile fenestrated drape, compresses, plasters, blood culture bottles etc. is needed. In this example, we want to charge a lump sum of 20 euros for these additional materials.

In total, in Germany a pleural puncture costs 112 euros at most. In the USA, however, a patient pays between 1,000 and 2,000 dollars for the same medical treatment, similar medical expertise and the same infrastructure.