Should doctors be in control of health care

At the request of the board of the German Medical Association (printed matter I-01), the Extraordinary German Medical Association adopts the following resolution with only a few dissenting votes and abstentions:

Patients and doctors need trust and a stable framework for good medicine. The patient is entitled to individual treatment in line with medical progress. To date, the insured have paid their contributions for such health care.

However, the doctor also needs the necessary time to be able to respond to the individual patient. The schematization and standardization of medicine are increasingly leading to the alienation of the patient-doctor relationship. The government-prescribed obsession with documentation ties up time that is lost for patient treatment.

The incapacitation of the patient and the tutelage of the doctor are the obvious consequences of this government's health policy. The previous achievements are badly talked about in order to build up a state-prescribed waiting list medicine. Because what is now being promised as an increase in efficiency is in truth the direct route to dispensing medicine. The patient then no longer has any prospect of individual treatment. Doctors will no longer be able to do what is required according to medical advances. The sick person becomes the norm and cost factor, the doctor the vicarious agent of the health insurance companies.

Health policy today is clearly planning to move from patient care to disease management.

Sensible working conditions in clinic and practice are necessary, under which good medicine is possible again. Concepts against the increasing shortage of doctors are also required.

Necessities for good medicine

The development towards a society of long life, the enormous possibilities of medical progress and the increased importance of health in the life of the individual mean a huge challenge for the financing of our health care system. A reorganization of social health insurance is inevitable if health care is to be possible for everyone in the future. The now planned course is therefore the most important turning point in the healthcare system since German reunification.

A reorganization of social health insurance must ensure

  • that patients get the health care they need individually,
  • that patients can decide for themselves whom they trust and which treatment they accept, patients want to control the treatment themselves in their own sovereignty and with the doctor as their partner,
  • that the funds for the tasks of the statutory health insurance are made available fairly.

The medical profession therefore calls on politicians to secure the freedom of the medical profession in this way

  • the treatment of the patient can be based on medical needs and not on economic requirements;
  • collaboration between doctors and other health professionals is encouraged, rather than conflict over financial resources;
  • the doctor can strive for the highest possible quality of patient care instead of being tied to the mediocrity of a state-prescribed medical program.

Key points of the Federal Ministry for Health and Social Security - or: Yesterday's recipes for tomorrow's problems

The Federal Government's outlook is a look in the rear-view mirror. Yesterday's prescriptions are intended to solve the problems of modern medicine and the health care of tomorrow that lie before us. Rigorous control of service providers, state dirigism and the allocation of medical services do not show that the government has really understood the problems of the health care system so far.

German Center for Quality in Medicine. If the government with the German Center for Quality in Medicine wants to open a kind of "Stiftung Warentest im Gesundheitsse", then it shows once again that this government wants to downgrade the health system to a market segment by only dealing with goods and services, not but about people and their needs. For the government, quality in medicine is reduced to control and state dirigism, which pushes the needs of the sick into the background. The schematization of diagnosis and therapy by a non-medical, government-installed body is not a guarantee of quality, but a justification of rationing and dispensing medicine.

Treatment TÜV. Medicine is not based on a mechanistic view of the world and it is not just a natural science. Medicine is above all an empirical science; the medical profession is committed to the principles of humane patient care. That is why further medical training needs diversity, and that is why further training is a professional obligation. The further development of the practice-related advanced training certificate created by the medical associations and the measures of Continuous Professional Development (CPD), i.e. the continuous development of skills including the corresponding documentation, makes sense. On the other hand, coercive measures and state controls that are used to monitor whether seminars and courses have been attended only suggest a deceptive security for the patient. There is not the slightest evidence in the international literature that recertification - and that is what we are talking about here - has a positive effect on patient treatment.

On the contrary, instead of promoting quality efforts, a system of repression will be built up here.

Destruction of the specialist structure. The government's reform proposals aim to radically thin out specialist medical care. According to the government's plans, patients should line up in the hospital in the future to receive specialist treatment. However, if the number of resident doctors is reduced, local, high-level specialist medical treatment is no longer possible. As in the public health system, patients will then have to accept longer distances and long waiting times for specialist treatment. In the short term it may save money, but in the long term the damage to people's health will be dramatic and sick people will primarily pay for it. This proposal is also another step in rationing and dispensing medicine.

Reform proposals from the medical profession

The patient is entitled to health insurance that deserves the name. But in the last eight years alone, 30 billion euros have been withdrawn from patient care to cross-subsidize other branches of social security. There would be no billion dollar deficit if the insured's funds were used only for patient care.

In addition to proper financing of the statutory health insurance, further development of the structures is necessary. The medical profession is ready for constructive cooperation:

Expand family doctor care. The society of a long life - in the year 2030 more than a third of the population is older than 60 years - the development towards a single society, but above all the increasing differentiation in medicine speak for a continuous care of the patient by a qualified person GP care. The exemplary testing of voluntary family doctor tariffs seems to make sense especially against this background.

Strengthen specialist medical care. Outpatient specialist care is one of the most important structural elements of the statutory health insurance. It guarantees care close to home that meets the patient's needs. Trends favoring a general thinning out of specialist outpatient care must be countered.

Continuous medical care. The previous boundaries between outpatient and inpatient treatment and the separate budgets must be overcome in favor of consistent patient care. The service should be provided where it can be carried out efficiently and in a patient-friendly manner. Hospital doctors should be included in highly specialized outpatient care on a person-by-person basis, beyond what is currently the case; Contract doctors should also be able to work more at the hospital.

Ensure the economic stability of the health insurance companies. For years, billions of euros (6 billion euros per year) have been withdrawn from the statutory health insurance through marshalling yards and non-insurance benefits. In addition, because it is linked to wages and salaries alone, the financing base is exposed to economic fluctuations and developments on the labor market. This construction of the revenue side is neither distributive nor future-proof, especially with regard to demographic changes.

Create more transparency. Every patient should have the right to be able to find out about the type, quantity, scope and also costs of the services provided for him. However, transparency also means that patients in health insurance are given the opportunity to participate in the decision-making processes.

Prevention strengthens quality of life. Increasing life expectancy and dwindling financial resources make prevention and personal provision increasingly important. In doing so, people should learn to understand that health-conscious behavior is worthwhile for them personally, as well as for the insured community as a whole. The medical profession therefore sustainably supports national prevention campaigns as well as the "Forum for Prevention and Health Promotion" planned and adequately financed by the Federal Ministry of Health.

Yes to a positive list. In view of the large number of drugs and the variety of information on drug therapy, a positive list can be an effective instrument for rational drug therapy. The prerequisite, however, is that such a list of prescription drugs is based on the current state of medical science and does not contain any medically questionable drugs. The book “Drug Ordinances” of the Drugs Commission of the German Medical Association is already a solid basis for the creation of a positive list.

National guidelines program. Ensuring and further developing the quality of medical work are part of the self-image of the medical profession and one of the primary tasks of medical self-administration. The medical profession itself has therefore developed medical-scientific guidelines as a decision-making aid for effective treatment. The individual decision in a specific treatment case is and remains a medical skill. However, a state-appointed central authority for quality, as currently planned, can only lead to standard medicine and the schematization of patient treatment.

It makes sense to have national guidelines that serve as decision-making aids, meet the criteria of evidence-based medicine and at the same time are constantly adapted to the rapidly growing possibilities of medical progress. The national guideline program under the patronage of the German Medical Association and with the participation of patient representatives is the consistent further development of such guideline work.

Defend patient rights. The most important patient right is the enforceable claim to high quality medical care that is in line with scientific knowledge. The patient is entitled to individual treatment and care tailored to his needs. This presupposes the doctor's freedom of therapy as well as the provision of the necessary resources. The patient is also entitled to a free choice of doctor. Patient rights and patient autonomy remain hollow phrases if this right to free choice and thus to the individual trusting relationship with the patient is abolished.

Create humane working conditions. Reduce excessive bureaucracy. Overworking doctors and nurses with millions of unpaid overtime endanger the security of patient care. Nonsensical bureaucratisation has a demotivating effect and deprives patient care of additional time.

Promote health services research. The German health care system is currently badly talked about with the negative attributes of over, under and incorrect supply. The reasons for this remain vague and do not stand up to scientific scrutiny. It is imperative to provide a solid description of the supply situation in the German health care system, which also includes an international comparison. The medical profession is ready to participate in establishing health services research in Germany.

The medical profession stands for social health insurance. But this requires a redefinition of subsidiarity and solidarity and personal responsibility. The problems that lie before us can no longer be compensated for by the commitment of the health professions alone.

A new social health insurance that can promise good medicine for everyone in the future will only emerge if we treat each other honestly and actually strive for intergenerational equity!