Finding your balance, letting yourself be carried for a while and then walking upright again – even Goethe allowed himself to be cured.

If you want to write about the great tradition of spa and rehabilitation medicine, the best place to start is with Goethe. This is the custom: there is hardly a cure book that does without the privy councilor and great poet. The reasons are obvious. Hardly anyone of such great fame was so obsessed with spending “quality time” in elegant seaside resorts as the poet and minister: to regenerate and rehabilitate oneself in a self-determined manner from everyday life, from rhyming and government office, that was one of Goethe’s life projects.

In older spa histories, before his naming became an embarrassing sign of dubious national pride, Otto von Bismarck, the “iron spa guest”, can at best compete with the poet.

The cradle of the health care system

Bismarck reigned 15 times for weeks from Bad Kissingen in Lower Franconia, today a Bavarian state spa and UNESCO World Heritage Site. The prince’s health was less iron than his image: the Prussian was prone to psychosomatic complaints and theatrical near-nervous breakdowns.

The fact that Bismarck became unpopular after the Second World War because of his tendency to use cannon salvos to make politics is also due to his actions in a second famous bathing resort: Bad Ems near Koblenz. There, in the middle of the Kurpromenade, the interests of Prussia (in the person of its King Wilhelm) collided with those of France (embodied in Ambassador Vincent Benedetti) on July 13, 1870.

Bismarck made the manipulative and notorious Emser Dispatch out of the conflict, which was hung on the question of the Spanish succession to the throne. He got the war he wanted with France and, as a result, the German Reich. The rest, they say, is history.

And from then on, with the beginning of the modern German nation-state, it increasingly affects each and every one of us as far as spa and rehabilitation medicine is concerned. Because Bismarck’s empire, with all its weaknesses, is the cradle of the German welfare state. Bismarck’s reforms, with the founding of the statutory pension, accident and health insurance funds, form the root of today’s care system for aftercare and prevention, the germ of rehabilitation with legal entitlement, the impetus for the change from the fashionable spa trip to inpatient (and meanwhile also often on an outpatient basis) Restoration of body and soul in rehabilitation.

Rehabilitation stays: Health as a common good

The Social Insurance Code (Reichsversicherungsordnung), which established the claims for all those with statutory insurance and (despite its name) was also valid in the Federal Republic for decades, has meanwhile become the Social Security Code. The rehabilitation “for people with disabilities and people threatened by disabilities” has had its own volume since 2001, the “Ninth Book of the Social Code” (SGB IX). The fact that “people at risk” were also included here is of the utmost importance: in order to get a place in a specialist clinic after a stay in hospital or from the stress of everyday life, you do not need to recognize a disability that has already occurred.

That is why the wide range of rehabilitation options in Germany is also aimed at people who are not disabled and, on top of that, at people who are at risk of illness, for example because of burnouts. And if you think about it, that’s a very sensible idea for the community of solidarity: You can hardly wish for tens of thousands of people to take early retirement because they simply can’t take it anymore – although they could have been helped effectively.

What serves the community also helps the individual: According to the express mandate of the legislature, rehabilitation should serve the sick and disabled “to promote their full, effective and equal participation in the life of society, to avoid disadvantages or to counteract them” ( § 1 SGB IX).

Apply for a rehab stay

Rehabilitation facilities have therefore become the third important pillar of the healthcare system alongside resident doctors and hospitals. Even in the 1990s, during the so-called “rehab crisis”, this was anything but certain, because much of what was delivered as usual in traditional health resorts was not medical and hardly up to date. There was sometimes very tough competition, and at times there was raging of the cutbacks, but there were soon constructive approaches for a fundamental modernization of the rehabilitation sector. And: essential achievements of the welfare state have been preserved for everyone in Germany.

One of them is the entitlement of children and young people to rehabilitation measures, which was also further secured in the SGBIX. Actually, it is not necessarily logical: Children do not pay any pension contributions, and the original provider of the rehabilitation offers, the pension insurance, would not necessarily have to vouch for them. But the concept of prevention has triumphed here as well: the aim is to help as many people as possible to live as healthily and as independently as possible.

However, this leads, as is typical for German federalism and the large number of our institutions, to a somewhat confusing landscape for the assumption of costs and applications for those starting out in rehabilitation: depending on the case, health insurance, pension insurance, state aid or a ( hopefully reasonably designed) private insurance. Applying for rehabilitation is generally not an overwhelming ordeal for those affected: if it is necessary after a stay in hospital, it is applied for from there, otherwise usually by the resident doctor.

Great variety – spoiled for choice?

The range of diagnoses that are treated in rehabilitation clinics today is as broad as medicine as a whole: it takes time and practice to get back on your feet after knee or hip surgery – you can get it in rehabilitation. The same applies after a heart attack or stroke. But that’s not all. The corona pandemic in particular has shown how important it is to take care of the soul in our time. So says Dr. Gernot Langs, chief physician in Bad Bramstedt, told the star that the stress on rehabilitation patients increased during the pandemic. The home office left her lonely, the fear of getting infected puts a strain on her nerves. “The number of registrations for rehabilitation is very high. But I can’t say whether they are higher than before Corona. But what we noticed: The number of registrations for young people in the acute area has gone through the roof,” says Gernot Langs.

The parent-child cure, formerly widely known as “mother’s recovery,” is another great achievement of German social policy. Peggy von Kügelgen and her family not only lost their house in the flood disaster last July, the clean-up work that followed took a lot of mental and physical strain on the mother. During a rehabilitation stay in Scheidegg in the Allgäu, she and her 8-year-old son Joshua regained their strength.

Like all persons entitled to rehabilitation in Germany, they too had the right to choose the location for their cure themselves. But hardly any of us are experts on this – medical advice can help, but so can the overview that our experts from the MINQ Institute have created for you with great effort: You will find 680 recommendations in 457 excellent rehabilitation clinics in this issue. This comprehensive overview, we hope, will prove valuable when making a personal decision.

The number of people who are cared for in prevention and rehabilitation facilities each year, often in traditional health resorts, is close to two million in non-Corona times. Well over 120,000 employees look after them. Done well, rehabilitation medicine comes close to the ideal of medicine: it is preventative, provides its own health expertise for its patients and creates quality of life. Often it also gives new confidence.

Goethe, to come back to him, was 82 years old – an achievement for someone born in 1749. His pronounced spa desire will certainly have played a role.

The method