you can be assured: All statutorily insured patients in Germany have access to a neurologist! Some neurologists (like other doctors) may decline to treat statutorily insured patients (When calling a doctor you will often hear the question “What is your insurance?” [“Wie sind Sie versichert?”]. If your answer is “statutorily insured” [“gesetzlich versichert” / “Kassenpatient”], some doctor’s offices might decline and say “Sorry, we treat only privately insured patients!” [“Tut uns leid; wir behandeln nur Privatpatienten!” / “Tut uns leid, wir sind eine Privatpraxis!”], and others may give you an appointment with more waiting time than you find acceptable because they want to reserve a number of time slots for the much more lucrative and desirable privately insured patients), but investing some time and effort for telephoning several doctor’s offices you will get an appointment! A reliable way to get a first appointment at a neurologist’s might be to go to a GP first and ask her/him for a medical referral to a neurologist and for the GP’s staff organizing this appointment (them
calling the neurologist and asking for the appointment). If symptoms are acute (e.g. in a relapse) you will probably get an appointment with a neurologist within three days if not immediately. If symptoms are not acute, you may have to wait some weeks or even months.
In my opinion the “second class” treatment of statutorily insured patients in Germany (in contrast to the better treatment of privately insured patients) in most cases is more annoying (Who wants to be treated as “second class”?) than really harmful, at least as long a you are able to invest more time and effort in getting the appointments that you may need.
Besides the medical practices of individual resident doctors who may differ widely in what they view as the best treatment or in what they are willing to prescribe, there are MS centers (“MS-Zentren”), where you can go to (independent of whether you are statutorily or privately insured). The certification of these MS centers is a responsibility of the German Society for MS (Deutsche Multiple-Sklerose Gesellschaft [DMSG], see www.dmsg.de
). These MS centers will treat you exactly according to the official guidelines for the treatment for MS, so that these guidelines set the standard, which you can rely on. You do not need to fear that you may not be able to obtain the treatment that these guidelines stipulate!
The German Neurological Society (Deutsche Gesellschaft für Neurologie [DGN], www.dgn.org
) is the body which issues the official guidelines for the treatment of MS (Leitlinien zur Behandlung der Multiplen Sklerose, see http://www.dgn.org/images/red_leitlinie ... engert.pdf
.) The current guidelines are outdated and are being prolonged provisionally for a couple of months from time to time while a general revision is currently under way. As you can see in figure 1 (Abbildung 1) on page 2 of the PDF the currently available DMTs for RRMS are dimethylfumarat (Tecfidera), glatirameracetat (Copaxone), several interferons, Teriflunomid (Aubagio), and (only!) for aggressive forms of RRMS Alemtuzumab (Lemtrada), Fingolimod (Gilenya) and Natalizumab (Tysabri). So, this is what you can get as a statutorily insured patient in Germany.
The availability of new medications for statutorily insured patients depends a) on the approval by the European Union’s EMA (European Medicines Agency) and b) on the inclusion into the DGN’s guidelines. For privately insured patients: only on the EMA’s approval and the “green light” given by the individual private insurance. E. g. ocrelizumab has not yet been approved by the EMA and can, therefore, not be prescribed within the EU. (A decision of the EMA on ocrelizumab is expected within the first months of 2018.) After that approval a neurologist in Germany will be allowed to prescribe ocrelizumab, but the big question will be whether the health insurance may be willing to cover the cost of the drug. Statutorily insured patients will probably only get it, after the drug has made it into the DGN’s official guidelines.
A treatment such as HSCT will probably not be covered by the statutory health insurance.
Please, take into account, that I am no expert and only describe how I myself – perhaps erroneously – understand the MS health care in my country. I refuse any liability for what I have written here!
It is impossible for me to offer advice for the case, that you may have the free choice between private health insurance and voluntary statutory health insurance. The cost of private health insurance is impossible to know, before you ask the different private health insurances and state all your risk factors and preexisting conditions (They will subject you to a detailed medical examination [going back 10 years or more into the past], ask you to release all your doctors from confidentiality, so that they can obtain all your past medical records ... Any voluntary or even involuntary [!] failure to disclose a risk will result in their rescission of the contract!).
Whether you are considering living in Germany for only a couple of years or for many years to come (and into your fifties, when it will become impossbile to switch health insurance to the then more affordable statutory health insurance.) may also play a role. Generally, the older and more vulnerable one is, the safer the statutory health insurance is, I would say.
If you have the free choice and opt for the statutory health insurance you will be bound to remain with the chosen health insurer for a minimum of 18 months, but are allowed to switch after these 18 months to another (statutory or private) health insurer, provided you give notice to leave 2 months before. Thus, you could for your first 18 months in Germany try out, whether you can live with the “second class” health service which the statutory health insurance provides.
Another thought: If you are considering a job offer in Germany, don’t let yourself be blinded by a very good looking gross salary! There are so many compulsory insurances (health + nursing care insurance, old age insurance, unemployment insurance) and deductions/taxes, that your net salary will be much lower. (E. g. my personal monthly net salary amounts to only about 57% of my gross salary.) Always ask what to expect as your net salary!
To your final question: The German law requires you to answer truthfully, if you are asked during a job interview whether you have a chronic disease or not (Personally, I was never
asked this question in a job interview, while I was younger, and I would be confident that you will not be asked this question likewise). As you know you have MS, you are, therefore, bound to answer “Yes”. You are not required to disclose, what
you have, and nobody should ask you that (If they do, you may decline to give specific information.) You may disclose your diagnosis, if you want to, but as the general perception of MS still is that of inevitable “fast decline”, I would rather dissuade you from disclosing more than is required by the law.
If you have a disabled person pass (“Schwerbehindertenausweis”) which states a degree of disability (“Grad der Behinderung”) of 50 or more (comparatively recently diagnosed as you are, you probably don’t have such a card), the German law requires you to state that fact as early as in your job application. The job interview will then be attended by the company’s disabled persons’ representative (“Vertrauensperson der Schwerbehinderten”), too, and you will be asked, whether you need any special devices, or you may be asked, whether you are able to perform e. g. a specific physical task that is required in the job (But again: Nobody is allowed to ask you, what
you have.). Depending on whether the company already complies with the German legal requirement to give 5% of their jobs to disabled persons (or to pay financial compensation for their failure to do so), it may even be desirable for the company to hire someone with a disability pass, in order to evade the fine. But of course, the companies try to comply with this legal requirement by hiring the least disabled persons who have such a disability pass – and for the lowliest payed jobs within their company (There is no such requirement that they need to fill 5% of every level with disabled people.) Personally, I have experienced in my life three job interviews, after I had received a disabled person pass (stating a degree of disability of 50 [I am mildly impaired in my walking – mostly speed and distance – , but not visibly so, I believe, and otherwise almost unimpaired]), that is: stating the fact of a disability pass (but not the diagnosis) in my application. None of these applications has been successful. In one of these three cases the person with the most decisive say positively knew (by chance), that I have MS. With hindsight I believe, that his fear I might sooner or later become a liability for the team because of my MS, persuaded him to give the job to someone else – a decision which had really unwelcome consequences for me (loss of responsibility, much less attractive tasks and a loss of income of 1/3). My personal experiences, therefore, would incline me to advise: Discrimination against disabled people is real. Don’t apply for a disabled person pass, before you have secured the indefinite work contract you will stay on until retirement! Don’t disclose anything to your employer unless you must! But other people will – hopefully! – look back on much better experiences!
Hope, you find this information helpful!