HAMBURG, Germany — If you’re searching for bobby pins, low cost lipstick or a protein bar, nicely, sorry, Americans, the German pharmacy can’t assist you to.
It’s not the CVS, Rite Aid or Walgreens of dwelling. Die Apotheke, as a pharmacy is thought right here, sells drugs. German drugstores might need some high-end make-up (hypoallergenic, and for delicate pores and skin!), lotions or child bottles. You’ll additionally positively discover magnesium dietary supplements and nutritional vitamins.
But they aren’t comfort shops stocking hair dryers, cellphone chargers, toys or groceries. This is the place you go for well being, and for drugs.
Germany’s well being care system, with its negotiated low drug costs and sturdy common insurance coverage program, is hailed as a forward-looking mannequin for the United States, which is hamstrung by ever-growing well being care prices and leaves hundreds of thousands of individuals uninsured. Could we study one thing from the pharmacies right here, too?
Carrying that query in thoughts, I wandered into three north Hamburg pharmacies, all inside a five- to 15-minute stroll of each other.
It seems that is the place the well being panorama will get slightly fuzzy. The pharmacies right here supply a glimpse into how Germany’s drug pricing system, for essentially the most half, retains medicine comparatively reasonably priced for customers. But whereas Apothekes current themselves as health-oriented hubs, they, like a lot else in well being care, are at the beginning companies.
German pharmacies would possibly promote some high-end make-up, lotions or child bottles, however they aren’t stocked with the big selection of things present in American shops. At Lillen Apotheke, in Hamburg’s upscale Eppendorf neighborhood, a pharmacist acknowledged that shops like hers promote pores and skin lotion, high-end nail polish (allegedly higher in your fingers) or pharmacy-exclusive mascara (additionally hypoallergenic) not primarily for well being causes however to make cash.
Unlike within the United States, and even different European nations, German pharmacies should be owned by pharmacists. Most drugs are prescription-based. And each buy of treatment — even one thing Americans contemplate “over-the-counter” like ibuprofen or chilly drugs — requires a dialog with the pharmacist first, to ensure sufferers perceive its results.
Economists right here aren’t positive the German approach is best.
For starters, there’s no proof that this particular requirement of a “talk” is in some way extra environment friendly or results in higher well being outcomes. While knowledgeable opinion is in some circumstances useful, it may be superfluous, too. For occasion, does somebody with menstrual cramps or a muscle sprain want the pharmacist’s recommendation earlier than getting ibuprofen?
“The benefits are meant to be safety,” mentioned Tom Stargardt, a professor on the University of Hamburg who research pharmaceutical economics. “The question is, ‘How much do you trust the consumer to be informed, to be able to judge the benefits of the drug?’”
Unlike within the United States or different European nations, German pharmacies should be owned by pharmacists. And each treatment somebody purchases at a German pharmacy requires a dialog with the pharmacist first, to ensure sufferers perceive its results.
Often, these conversations are fast and cursory. At La Vie Apotheke, on a crisp Friday morning, a pharmacy session for aspirin took about half a minute.
German pharmacists have a strict monopoly on dishing out drugs, and that undermines the potential for worth competitors, economists mentioned.
Also, medicine right here have a set worth. A government-backed panel defines what public insurance coverage can pay. Then, wholesalers can add a markup, outlined by statute. Pharmacists can add another, additionally legally prescribed. That’s it.
It’s a window into the ethos of the nationwide well being care system. “Every prescription drug costs the same in every pharmacy,” Stargardt mentioned. “The reason is that every person should have the same access. Whether they live in a rural area [or a city], they shouldn’t be punished in terms of prices.”
Drugs right here already price lower than within the United States. For occasion, Humalog, a model of insulin, lists a $55 worth per vial, in contrast with a median of tons of of dollars again dwelling.
And German sufferers sometimes don’t even see that expense. If a health care provider prescribed the drug, insurance coverage sometimes should cowl it, that means sufferers pay nearly nothing. (When a less expensive generic is on the market right here, pharmacists are legally required to offer that model, until the doctor explicitly says in any other case.) For insured Germans with persistent sicknesses, the state caps well being price sharing at 2% of their family revenue.
The lozenges on the market at Lillen Apotheke in Hamburg’s upscale Eppendorf neighborhood are sandwiched between licorice candies and fruit gummies.
There are exceptions. One that’s in putting distinction to American well being coverage: Insurers aren’t required to cowl contraception tablets for ladies older than 22. Pharmacists mentioned that expense can run as much as 60 euros monthly — about $67 U.S. dollars — relying on the model a lady will get. Under the Affordable Care Act, American insurance coverage should cowl contraception as a type of preventive drugs, with no price sharing.
And, pharmacists and economists alike will acknowledge, even with the well being halo impact German pharmacies take pleasure in, die Apotheke and the Walgreens have a standard motivation.
At Lillen Apotheke, in Hamburg’s upscale Eppendorf neighborhood, a pharmacist acknowledged that shops like hers promote pores and skin lotion, high-end nail polish (allegedly higher in your fingers) or pharmacy-exclusive mascara (additionally hypoallergenic) not primarily for well being causes — however relatively, to drive earnings.
Take the lozenges on the market. They’re sandwiched between licorice candies (of which sugar is the primary ingredient) and fruit gummies made specifically for pharmacies, which declare to have pure nutritional vitamins, too. And, after all, these are positioned subsequent to the chocolate.
What’s the well being worth there?
“Oh. That’s just for fun,” the pharmacist mentioned.
Shefali Luthra is at the moment reporting from Germany as a 2019 Arthur F. Burns Fellow. The fellowship is an change program for German, American and Canadian journalists operated by the International Center for Journalists and the Internationale Journalisten-Programme.