The German healthcare system has long been unfathomable for many patients. One of the obvious strange things will soon be over: chronically ill people who regularly need the same medication will no longer have to go to the doctor every quarter to pick up their prescription. In the future, one visit to the practice per year will be sufficient. Sick notes should also be possible on a long-term, uncomplicated basis by calling a doctor.
This Tuesday, Federal Health Minister Karl Lauterbach (SPD) presented the next major restructuring of the German healthcare system after the hospital reform. At least that’s what he calls his plans. This time it’s about family doctors, and a little bit about specialists such as gynecologists, internists, ophthalmologists and ENT doctors. In addition to the issue of prescriptions and sick notes, Lauterbach primarily wants to restructure the fee system. “We want to de-economyize general practitioner practices,” he said on Tuesday afternoon after a summit with doctor representatives and health insurance companies.
The summit came about because the resident doctors protested. They demand better salaries, less bureaucracy and more help with digitalization. The Praxis in Not alliance, an association of numerous medical associations, warned that outpatient medicine was bleeding dry and was being cut back and called for practices to be closed at the end of the year – and if no agreement was reached in the new year either.
The income development for employed doctors is much more attractive than for practicing doctors, with less exposure to business risks and less administrative effort.
Dominik von Stillfried, Central Institute for Statutory Health Insurance
The pressure on Lauterbach was high. And the Health Minister actually signaled on Tuesday that he wanted to accommodate doctors in private practice. In the future, patients should only see a doctor if it is medically necessary. And not because, according to the fee system, it is necessary for doctors to be reimbursed for their services by the health insurance company. “We will see a lot fewer patients in the family doctor’s office,” promised Lauterbach. In addition, home visits should be financially supported and practices that provide certain services but do not get their money’s worth because there are too few patients should receive a flat rate as compensation.
But the biggest change is something else: the end of so-called budgeting for general practitioners. Many doctors are currently faced with the problem that the health insurance companies impose an upper limit on their fees per quarter. If they have to treat more patients, they receive no more money or receive significantly less money; they practically work for free. Many practicing doctors see this as a great injustice.
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Dominik von Stillfried, the chairman of the Central Institute for Statutory Health Insurance (ZI), has also long been critical of the budgeting of medical services. “Debudgeting would be a solution to financially strengthen resident doctors,” he told ZEIT ONLINE before the summit. The ZI has calculated how often patients are treated by doctors without being reimbursed. There are no less than 125 million doctor contacts per year, more than 10 million of which are due to diabetes, acute respiratory infections and back pain.
This should now be an end for family doctors, said Lauterbach. Accordingly, the head of the General Practitioners Association, Markus Beier, also praised Lauterbach’s plans as “right and important”.
The Virchowbund medical association, which represents not only general practitioners but also specialists for whom the upper fee limits are not being lifted across the board, is downright angry. Accordingly, no specialist medical representative appeared with Lauterbach at the press conference, although someone had previously been present at the meeting, Lauterbach explained. Instead, Virchowbund chairman Dirk Heinrich was angry in a press release: Lauterbach was ignoring the specialists and Lauterbach’s actions were an “attempt to divide the medical profession.”
Less “nagging” by health insurance companies
However, practicing specialists generally earn significantly more than general practitioners – so in theory they have significantly less to complain about. Just like general practitioners, they also suffer from a real explosion in costs. This, explains Dominik von Stillfried, is not just due to inflation, which picked up speed in 2022. Between 2018 and 2021, practice income increased by 16.4 percent, but expenses increased by almost the same amount. In addition to personnel costs, the main drivers of this development are expenses for maintenance and repair, materials and laboratories, as well as rising rents. “The income development for employed doctors is much more attractive than for practicing doctors, with less exposure to business risks and less administrative effort,” says von Stillfried.
The Health Minister did not answer the question as to why Lauterbach still exempts the specialists. He spoke cloudily of a constructive discussion. “We check everything,” he said, nothing more. Virchowbund boss Dirk Heinrich doesn’t seem to be enough. He maintains that specialists also need to be debudgeted, announced further protests and gave the Minister of Health an ultimatum. “There must now be concrete improvements quickly, including in specialist medical care. Otherwise there will be further practice closures by the end of the quarter at the latest,” he told ZDF.
However, what the specialists should also benefit from is less bureaucracy. For example, applications for psychotherapy should be made much easier. Above all, health insurance companies should place more trust in doctors when it comes to billing. Many residents find the regular financial performance audits by the health insurance companies to be almost a nuisance. These are now to be significantly restricted by introducing a trivial limit below which there will no longer be any examinations: in the future, no doctor will have to produce pages of documents for just a few euros.
Collaboration: Jakob Simmank
The German healthcare system has long been unfathomable for many patients. One of the obvious strange things will soon be over: chronically ill people who regularly need the same medication will no longer have to go to the doctor every quarter to pick up their prescription. In the future, one visit to the practice per year will be sufficient. Sick notes should also be possible on a long-term, uncomplicated basis by calling a doctor.
This Tuesday, Federal Health Minister Karl Lauterbach (SPD) presented the next major restructuring of the German healthcare system after the hospital reform. At least that’s what he calls his plans. This time it’s about family doctors, and a little bit about specialists such as gynecologists, internists, ophthalmologists and ENT doctors. In addition to the issue of prescriptions and sick notes, Lauterbach primarily wants to restructure the fee system. “We want to de-economyize general practitioner practices,” he said on Tuesday afternoon after a summit with doctor representatives and health insurance companies.