Lowest Implementation Body in Social Politics
The results of the Commonwealth Fund (CWF) Study seem to have left the authors utterly bewildered. They suspect themselves that in the context of this study, not all areas were covered that might explain the strikingly high dissatisfaction among Germany’s primary care physicians. However, the problems are common knowledge and have found their way into multiple publications. Germany’s statutory health insurance system is based on a body of rules and regulations that would be unimaginable in other countries. The conditions under which Germany’s primary care physicians are laboring are:
- The ongoing conflict between social politicians’ and health insurers’ public promises of unlimited services, with concealed rationing at the level of the service providers
- Fragmentation of services as a means of controlling costs
- Threats of legal recourse in a Byzantine legal system (an impenetrable mess of unclear and contradictory rules, collective liability, penalties without proven guilt)
- The abolition of basic rights for the doctors contracted to work for the statutory health insurers (freedom to form coalitions, freedom to set their own fees)
- A centralized planning economy with a detail-obsessed mania for regulations, whose implementation requires enormous resources in each and every practice
- A lack of scientific understanding of primary care physicians’ activities. The concept of evidence based medicine can thus far be applied only to narrow segments of primary care doctors’ work.
In the past 30 years, general practices have mutated into the lowest-level implementations bodies within social politics. Patient oriented medicine in the system of contracted doctors is often only possible by breaking existing regulations, accepting economic sanctions, and working any amount of unpaid overtime.
Dr. med. Reinhard Reitmeier
|1.||Koch K, Miksch A, Schürmann C, Joos S, Sawicki PT: The German health care system in international comparison: The primary care physicians’ perspective. Dtsch Arztebl Int 2011; 108(15): 255–61. VOLLTEXT|