Hospital.Help

Berlin The supply crisis that the German health care system is currently facing cannot be ignored any longer. The Professional Association of German Internists (BDI) warned politicians today.

The fact that the care crisis has already begun can be seen, for example, in the fact that it is becoming increasingly difficult for patients to get appointments in the outpatient sector, said BDI President Christine Neumann-Grutzeck today at the association’s capital conference. Some patients can no longer find a family doctor.

Against this background, politicians must stop giving patients an unlimited promise of services that the health system cannot keep due to a lack of financial and human resources.

It cannot be the case that politicians now suggest that round-the-clock care is possible for patients at all times, criticized Neumann-Grutzeck. Instead, politicians must strengthen those who take over the care by reducing bureaucracy, for example, or by providing appropriate funding.

We must now invest the money that is available to us in the structures that we will need in the future, demanded the BDI President. And we must begin to guide patients to where they will receive the best possible care. To do this, we need a uniform initial assessment in emergency care, for example.

The health policy spokesman for the Union faction in the Bundestag, Tino Sorge, put forward a proposal for better patient management. Management should be more based on incentives, said Sorge. If people go to many specialists, they should consider a higher health insurance rate, he suggested.

A flat-rate mentality must be counteracted, said Sorge. Innovative control models could achieve a lot. In addition, there is a need for a significant reduction in bureaucracy and a less culture of mistrust in the health system, he stressed.

Improve framework conditions for medical practices

Neumann-Grutzeck also insisted on improving the general conditions for doctors so that they can continue to pursue their profession and not give up their practice in frustration for bureaucratic or financial reasons. This includes how self-administration is organized and how one can set up outpatient care, said Neumann-Grutzeck. Above all, strengthening the practices is central.

Lower Saxony’s Health Minister Andreas Philippi (SPD) also spoke out in favor of making general medicine more attractive. In Lower Saxony, discussions are underway to make general medicine courses more attractive for students by creating chairs for general medicine at university hospitals, he said.

In addition, we are discussing with the Association of Statutory Health Insurance Physicians in Lower Saxony how we can advance the practical year (PJ) in rural areas. We have some good ideas, said Philippi.

Neumann-Grutzeck then replied that when strengthening general medicine, internists should not be forgotten. Around 30 percent of family doctors are internists, she pointed out. When she demanded that they also need more funding, she received great applause from the assembled doctors.

Inadequate remuneration leads to abandonment of the medical practice

One participant in the Capital Forum, an endocrinologist from rural Lower Saxony, reported that she had done exactly what was often desired in order to ensure rural care. She had moved to an underserved region and set up a practice there.

However, she fears that her practice will go bankrupt because the remuneration for her services will not be sufficient. The only mistake she made, explained the endocrinologist, was not taking over a practice, but rather starting a new one under the burden of high investment costs.

Another participant in the capital forum explained that a structure has developed in the outpatient sector that only pays for rubbish. Doctors’ practices often book patients in to survive financially and not necessarily because it is medically necessary, the doctor explained. He therefore called for a different remuneration structure for the outpatient sector.

A de-budgeting of all GP and specialist services, including a comprehensive EBM reform, would help, the BDI explained in a current position paper. The negative consequences of budgeting are becoming increasingly noticeable, it says. Although the majority of patients are treated in practices, statutory health insurance expenditure on inpatient care is twice as high despite falling case numbers.

Contracted doctors are exhausted and demotivated by this development. A shift in services to outpatient care is therefore only possible with a de-budgeting of general practitioners and specialist services, it continues.

Strengthening of further training required

In this context, the BDI is also calling for sustainable financing of outpatient training. In order for general practitioners and specialist practices to be able to provide training across the board, specialist training must be adequately reflected in the contractual medical remuneration system, writes the association.

With the outpatient sector, medical training is also increasingly shifting to the outpatient sector. However, the EBM does not reflect the medical performance of the trainee nor the cost of the training.

The funding is therefore provided through a separate grant, from which internists in both the general and specialist areas are largely excluded. The expansion of the continuing education funding would be an effective short-term measure to create urgently needed continuing education capacities, emphasises the BDI.

In order to strengthen primary care, almost a third of which is provided by internists, it would be necessary to promote outpatient training to become a specialist in internal medicine, similar to that for a specialist in general medicine. Overall, however, the existing funding no longer meets the increasing demand in all specialist groups. © cmk/fos/aerzteblatt.de