Health insurance companies: There is no shortage of doctors

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New care law planned: health insurance companies deny shortage of doctors

Medical care for patients in Germany is again under discussion. While the health insurance companies can see no problems in patient care, critics such as the resident family doctor and SPD city councilor from Ingolstadt, Anton Böhm, warn of the possible consequences for the health system.

After various experts had warned of an impending shortage of doctors (especially in rural regions) at the end of last year, the Federal Minister of Health Philipp Rösler (FDP) had it checked whether there are enough physicians in Germany available to provide the population with good medical care close to where they live. The information provided by the health insurance companies is clear at first glance. "Germany has more doctors than is needed for good medical care," said the head association of statutory health insurers on Monday. However, critics criticize the basis of calculation that was used by the health insurance companies in the course of their survey and assume that there is an actual shortage of doctors.

Working hours of doctors not taken into account According to the information provided by the health insurance companies, there are around 24,000 doctors in practice in Germany too many, so that in theory every fifth doctor is superfluous. Patients who sometimes wait for an appointment for days or weeks are unlikely to understand this statement. Critical experts also see considerable deficiencies in the information provided by the health insurance companies. Because the health insurance companies used the calculation of the federal government's demand planning, which determines how many doctors per inhabitant should work in a region. But the number of physicians in private practice says nothing about how long they are available for patient care. The number of medical professionals increased significantly between 1997 and 2007, but the average number of hours worked per week fell 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 companies in order to record the actual status of medical care. In addition, the demand planning dates from 1993 and has little to do with today's realities in medical care, according to the critics.

Medical surplus only theoretically A medical surplus, as announced by the health insurance companies, is therefore only available on paper. In reality, the significantly increased number of doctors is offset by more part-time work and shorter overall weekly working hours. When looking at the total number of hours worked in relation to the significantly increased number of illnesses to be treated, it becomes clear that physicians today actually have less time to treat a patient than in the past. Here it is reasonable to assume that the health insurance companies do not want to confirm the lack of doctors for a certain reason: Because more doctors also cost more money. In the opinion of the critics, however, the health insurance companies should not ignore the reality, since the number of young doctors will not be sufficient to replace the doctors who will soon retire and the lack of doctors will also lead to restrictions in patient care at the latest.

Patient care suffers from maladministration in the health system Another point to be criticized, according to system critic Anton Böhm, is that physical examinations and conversations are hardly paid for, but the technology is paid for all the better. "The farther the doctor is from the patient, the better he deserves", emphasized Böhm and added: "There are more nuclear spins in Munich alone than in the whole of Italy", but in "basic care we are starving." discussed the upcoming shortage of general practitioners in the country, but pointed out that the whole medical landscape is changing. Today there are many female doctors who want to work part-time or after a break of several years. However, legislation here only allows employment in medical care centers. The practices, on the other hand, cannot hire doctors, but must involve them as partners if appropriate employment is planned. However, according to Anton Böhm, many of the physicians affected are not ready to take this step, since participation in a practice is more difficult to reconcile with family life and leisure needs.

Wrong incentives in the health system? The system critic Böhm also criticized the coding scheme, which is the basis for billing between health insurance companies and doctors. "So how should we make money? By coding up serious illnesses for our patients? ”Is the provocative question of the critical family doctor. Böhm explained that patients actually only become profitable when they are "sick on paper, but otherwise healthy". Associated with this is an incentive to code for sick people and an enormous amount of bureaucratic effort that keeps the doctor from his actual tasks - namely the treatment of patients. In addition, the tight competition among health insurance companies led to the fact that huge amounts of money flow into administration and advertising instead of patient care, explained Böhm. "The administration of the health insurance costs as much as the resident doctors," according to the system critic. In addition, Böhm complained that the change of many young, well-earning members towards private health insurance (PKV) would draw additional money from the solidarity-based health system.

Federal government plans fee surcharges to remedy shortage of doctors Despite the statements of the health insurance companies, the Christian-liberal government coalition is planning significant additional expenditures to remedy the shortage of doctors, particularly in rural regions, as part of the redesign of the health care law. Among other things, fee surcharges for doctors in sparsely populated areas are planned, and hospitals in rural regions are to receive surcharges for the training of general practitioners, the government said. In the interests of patients, prescriptions for medication should also be relaxed. No wonder that the statutory health insurance companies go on the barricades. Because according to estimates by the AOK Federal Association, the planned legislative initiative would cost several billion euros if all measures were implemented, which the insured might have to pay out of their own pocket in the form of additional contributions or premium increases. According to the deputy head of the National Association of Statutory Health Insurance Funds, Johann-Magnus von Stackelberg, there is nothing wrong with incentives in sparsely populated regions of the country as long as the insured do not have to pay for it.

Remuneration not a reason for a lack of doctors? The deputy head of the National Association of Statutory Health Insurance Funds emphasized: "We have 25,000 resident doctors too many in oversupplied areas and only 800 resident doctors insufficient in deficient regions", which is why surcharges in deficient regions should be combined with discounts in oversupplied areas. The problem with medical care lies in the distribution of the funds and not in the amount of the medical fees, said the vice-chief of the National Association of Statutory Health Insurance Funds. Von Stackelberg therefore called for better distribution within the medical profession rather than an increase in medical fees. Because a resident doctor earned an average of 169,000 euros in 2011, 5,000 euros more than in the previous year. The lack of remuneration could therefore not be a reason for the forecast shortage of doctors. (fp)

Read on:
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Sharp rise in doctor's fees

Image: Thommy Weiss /

Author and source information

Video: How to Fix the Global Physician Shortage - Change Medical Education. Dr. Peter Horneffer. TEDxHHL


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