No sustainability of the healthcare system?

Gloomy future expectations: Only 16 percent are convinced that today's care can be maintained - 79 percent expect an increasing two-tier medicine

23.11.2011

Patients and doctors fear a care emergency in Germany and accuse the policy of inaction. At the same time, physicians in particular see a growing shortage of doctors, especially in the eastern federal states patients already report a limited supply. All in all, the Germans rate the current health care system as positive - albeit with significant regional differences: the people in Saxony and Berlin are the most satisfied, while Mecklenburg-Western Pomerania and Thuringia are laggards where the shortage of doctors is already clearly noticeable. The population and physicians are pessimistic about future developments and expect more and more cuts. Even today, more than a third of physicians have to postpone treatment, at least occasionally, for cost reasons. These are some key findings of the 6th MLP Health Report. The representative study commissioned by the financial and wealth adviser MLP has been commissioned by the Allensbach Institute for Demoscopy with the support of the German Medical Association.

Politics undertakes too little against feared care needs
More than one in two cares about his or her financial security in the case of long-term care. Trust in statutory long-term care insurance has also declined significantly: More than three quarters now fear that the benefits provided by good care will not be enough (2010: 64 percent). The doctors are even more worried about 80 percent. Accordingly, they judge negatively about the policy: This must do more for the topic of care, claim 82 percent of doctors and citizens. However, large sections of the physicians (46 percent) and the population (43 percent) are skeptical as to whether politics can at all ensure good care for all those in need of care. „The policy has recently decided on the entry into a capital-covered additional insurance“, says Dr. Uwe Schroeder-Wildberg, CEO at MLP. „This is a real step, but not enough. The citizens have also supported a form of care reform, with which the challenges are tackled at the root - the MLP health report clearly shows.“ Faced with the election, a majority of 43 percent of the population is in favor of compulsory supplementary insurance, and only 15 percent in favor of increasing contributions to the statutory long-term care insurance. Even clearer is the picture among the doctors: 72 percent plead for a mandatory supplementary care insurance.

Worries about lack of doctors have increased significantly
Above all, the doctors are increasingly finding a shortage of doctors: Already today almost two thirds (2010: 46 percent) see a problem; another 23 percent will use it in the future. The results also show a clear east-west difference: in eastern Germany, 69 percent speak of a shortage of doctors in their region, in the west there are only 47 percent. Significantly less than the doctors feel the population so far the shortage of physicians (13 percent), but about one in five expects it. People in structurally weaker regions with fewer than 25,000 inhabitants are particularly affected nationwide: 20 percent are already experiencing a shortage of physicians and 29 percent are counting on it.

As with care, there is great dissatisfaction with politics. Overall, physicians with 72 percent (2010: 73 percent) continue to have no good impression of the health policy of the Federal Government; in the population it is 55 percent (2010: 61 percent). A clear medical majority of 70 percent believes that the legislator underestimates the shortage of physicians and their effects - despite the recently launched pension structure law. However, most of the cornerstones of the law are welcome. For example, 95 percent of physicians support measures to improve the compatibility of family and career. Another 90 percent are in favor of financial incentives to share a rural supply contract with colleagues.

The President of the German Medical Association, Dr. med. Frank Ulrich Montgomery, the government sees the GKV supply structure law basically on the right path: „The law is intended to help ensure that patients continue to find a doctor near them. Despite all the criticism of individual specifications are basically correct steps.“ In the medium and long term, however, further measures would be necessary to make the health system future-proof. „We need to discuss how, given limited finances, capacities and time resources, we can provide all patients with the necessary treatment on a permanent basis. That's why we initiated the prioritization debate and are consistently pursuing it.“ It is undisputed that under the current financial conditions medical progress will no longer be reflected in the practices and clinics - certainly not in a society of long life. „If funding is not adjusted to supply needs, then policy will sooner or later have to face the prioritization debate“, says Montgomery.

Positive judgment on current health care
Overall, satisfaction with the healthcare system and current health care has grown again in recent years. 72 percent of the population and 88 percent of physicians judge „Well“ or „very well“. A 59 percent majority of the population has had consistent medical care over the past two or three years (2010: 56 percent). At the same time, the worries of having to forego necessary treatment in the event of illness are lower than in previous years - but still widespread at 32 percent. For physicians, more than two-thirds questioned their freedom of therapy for cost reasons (2010: 72 percent). Displacements are widespread for budgetary reasons: 59 percent of physicians have ever had to move treatments to a later period, and 16 percent are even more likely to do so. In the past two or three years, 20 percent of the patients had to wait longer for an appointment - 9 percent of the privately insured. At the same time, 72 percent of physicians confirm from their own experience that they frequently receive patients in their practice who do not need a doctor's visit from a medical point of view.

In Thuringia, the lack of doctors is particularly noticeable
In Mecklenburg-Vorpommern and Thuringia, the lowest level of satisfaction with the health system and healthcare prevails nationwide. The Thuringians are already the clearest perceived lack of doctors (43 percent), least of all the Saarlanders (2 percent). At the same time, most patients in Thuringia also complain about longer waiting times in the last two or three years - both in terms of appointments (35 percent) and appointments in the waiting room (36 percent). In Berlin, the few had to wait longer for an appointment (12 percent). Worries about not receiving the necessary treatment in the event of illness for cost reasons are particularly pronounced in Thuringia (58 percent); in Rhineland-Palatinate (16 percent), the few are concerned. The complete countriesOverviews are available as a chart at www.mlp-gesundheitsreport.de.

Gloomy future expectations and low willingness to reform
The development over the next ten years continues to make the population very pessimistic. Just 16 percent are convinced that today's care can be maintained for all sections of the population. By contrast, the vast majority expect additional burdens and restrictions: 79 percent expect rising cash contributions, and 78 percent higher co-payments for drugs. It is also becoming more and more one „Two-tier health care“ come (79 percent). In addition, many citizens expect that demographic change will increasingly burden the healthcare system: 61 percent expect fuller medical practices and problems to get an appointment. 51 percent even assume that expensive treatments in older people for cost reasons are no longer performed. Against the background of an aging society, doctors have a similar opinion: a broad majority still sees the health care system insufficiently prepared for demographic challenges. Eighty-six percent of doctors consider further fundamental reforms necessary. In the population, around three quarters say that reforms are indispensable. Despite this insight, the majority of the population rejects far-reaching reforms: An increase in cash contributions is 89 per cent unreasonable (2010: 87 per cent); restrictions on free choice of doctors are 87 per cent (2010: 85 per cent). A large majority of the population (82 percent) is aware that one can contribute a great deal or a great deal to maintaining one's health. However, the survey results also show that the focus on health has not increased in recent years: since 2005, only around a third have been very concerned about their own health.

The MLP Health Report is a representative survey of around 1,800 citizens and more than 500 physicians. For the first time this year, the key questions for the assessment of health care by federal states were collected. (Pm)