Health insurance There is no shortage of doctors

New supply law planned: Health insurance companies dispute medical shortage

01/03/2011

The medical care of patients in Germany is once again under discussion. While the health insurance companies can not detect any problems with the patient care, critics like the general practitioner and SPD city councilor from Ingolstadt, Anton Boehm, warn of the possible consequences for the health care system.

After several experts had warned of an imminent shortage of doctors (especially in rural areas) at the end of last year, the Federal Minister of Health Philipp Rösler (FDP) asked whether there are enough physicians in Germany who are available for good, local medical care. The information of the health insurance companies is clear at first glance. „Germany has more doctors than needed for good medical care“, Thus the announcement of the top federation of the legal health insurances on Monday. But critics complain about the basis of calculation, which was used by the health insurance companies in the context of their survey and assume an actual shortage of physicians.

Working hours of doctors not considered
According to the information provided by the health insurance companies, there are about 24,000 physicians in Germany too much, so theoretically every fifth physician is superfluous. Patients who wait for days or even weeks for an appointment may not be able to understand this statement. And even critical experts see in the information provided by the health insurance significant shortcomings. Because the health insurance funds have based their calculation on the needs planning of the federal government, which determines how many doctors per inhabitant in a region should work. However, the number of resident physicians does not say anything about how long they will be available for patient care. Although the number of physicians between 1997 and 2007 has increased significantly, the average number of working hours per week has dropped from 36.8 to 33.2 hours, reports the German Medical Association. Consequently, the working hours of the doctors would also have to be taken into account in the calculations of the health insurance funds in order to record the actual level of medical care. Moreover, the requirement planning dates back to 1993 and has little to do with today's realities in medical care, the critics say.

Medical surplus only theoretically
A medical surplus, as announced by the health insurance, there is therefore only on paper. In reality, the significantly increased number of physicians is compensated by more part-time work and shorter working hours. Looking at the total number of hours worked in relation to the significant increase in the number of cases to be treated, it becomes clear that doctors today actually have less time to treat a patient than before. This suggests that the health insurances do not want to confirm the shortage of doctors for a reason, because more doctors also cost more money. However, according to the critics, the health insurances should not deny the reality here, since the number of young physicians will not be enough anyway to replace the soon retiring physicians and the lack of doctors at the latest then lead to restrictions in patient care.

Patient care suffers from maladministration
Another point to complain about, according to the system critic Anton Böhm, is that physical examinations and discussions are hardly paid, but the technology is even better remunerated. „The further the doctor is away from the patient, the better he earns“, emphasized Böhm and added: „Munich alone has more nuclear spins than Italy“, but in the „Basic food we starve.“ Böhm not only underscored the already widely discussed shortage of family doctors in the countryside, but also pointed out that the entire medical landscape is changing. Today there are many female doctors who want to work part time or after a break of several years. However, the legislation only allows employees to work in medical care centers. On the other hand, the practices can not hire doctors, but have to involve them as partners if such employment is planned. According to Anton Böhm, however, many of the physicians concerned are not prepared to take this step, as participation in practice is more difficult to reconcile with family life and the need for leisure time.

Wrong incentives in the health system?
In addition, criticized the system critic Böhm, the coding scheme, which underlies the settlement between health insurance and doctors. „What should we use to earn money? By coding our patients into serious illnesses?“, so the provocative question of the critical family doctor. Patients do not really become profitable until they are „sick on paper, but otherwise healthy“ are, explained Böhm. Associated with this is an incentive for sick-coding and an enormous bureaucratic effort, which keeps the doctor from his actual tasks - namely the treatment of patients. In addition, the tight competition among health insurance companies has led to huge amounts of money flowing into administration and advertising instead of into patient care, Böhm explained. „The administration of the health insurance costs as much as the physicians“, so the presentation of the system critic. In addition, the change of many young, well-earning members in the direction of private health insurance (PKV) withdrawn additional money from the solidarity-based health care system, complained Böhm.

Federal government plans to raise fee surcharges to reduce the number of doctors
The Christian-liberal government coalition plans despite the statements of the health insurance companies in the context of the redesign of the pension law significantly overspend in order to remedy the shortage of physicians, especially in rural areas. Thus, among other things, fee supplements for doctors in sparsely populated areas are provided and hospitals in rural areas should receive supplements for the training of interns in general medicine, it said from ranks of the federal government. In the interests of patients, the prescriptions for the prescription of drugs should also be relaxed. No wonder that the statutory health insurance companies go to the barricades. Because according to estimates of the AOK Federal Association, the proposed legislative initiative would cost in implementing all measures several billion euros, which would have to be paid by the insured in the form of additional contributions or contribution increases out of pocket. According to the deputy head of the GKV umbrella organization, Johann-Magnus von Stackelberg, there are no objections to incentives in sparsely populated regions of the country, as the insured persons do not have to pay for it.

Compensation no reason for lack of doctors?
The deputy head of the GKV-Spitzenverband emphasized: „In oversupplied areas we have too many 25,000 physicians in private practice, and in deficient regions only 800 doctors in private practice“, why supplements in deficient regions should be linked to discounts in over-served areas. The problem with the medical care lies in the distribution of funds and not in the amount of medical fees, said the vice-chairman of the GKV-Spitzenverbandes. Von Stackelberg therefore called for a better distribution within the medical profession rather than an increase in doctors' fees. For a resident physician had earned in 2011 with an average of 169,000 euros 5,000 euros more than in the previous year. The lack of compensation could therefore not be a reason for the predicted shortage of doctors. (Fp)

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Image: Thommy Weiss