Are outpatient care and guarantee contracts still up to date? That is what symposium of the German Society for Statutory Health Insurance Physicians was all about.
And now, gentlemen, I wish you all good holidays! ”After the closing remarks by the State Secretary of the Interior, Clemens Delbrück, at 9:30 in the evening the recorder in the Reich Ministry of the Interior finally finished work on December 23, 1913. Previously, the representatives of the doctors and health insurance companies signed the contract with their almost 400-page verbatim protocol, which, as the “Berlin Agreement” 100 years ago, marked the beginning of joint self-government.
"That the regulation, as it was agreed today, may prove to be blessing for health insurers and doctors in the long run, "said the representative of the company health insurance funds, Councilor of Justice Konrad Wandel, when the contract was signed in the evening. The chairman of the German Medical Association, Medical Councilor Hugo Dippe, paid tribute to the services of the state mediators: “I think I am speaking on behalf of everyone, if I ask you not to part, before we thank the gentlemen from the ministries and especially Excellency Delbrück our deepest thanks for the fact that he brought us together and, through his excellent management of the negotiations, made it possible for us to come to such an unexpectedly favorable result. "
In fact, government intervention was required to get doctors and health insurance companies on the path of shared responsibility for the medical care of the insured. Before that, with the expansion of the statutory health insurance introduced in 1883 to include more and more sections of the population, the tensions between doctors and health insurers had steadily increased. The health insurance companies were increasingly able to conclude contracts with doctors on their own terms. The health insurance companies were only able to counter the growing demand power of the health insurance companies with the founding of the "Association of Doctors in Germany for the Protection of Their Economic Interests", later the Hartmannbund, in 1900.
The years before the Berlin Agreement were marked by Series of medical strikes. A Reich-wide strike was announced for the beginning of 1914 - reason enough for the Interior Ministry to vigorously advocate negotiated solution. The Berlin Agreement ended the licensing autonomy of the health insurance funds and transferred this to contract and registry committees with equal representation. At least one doctor was permitted for every 1,350 insured persons.
Are outpatient care and guarantee contracts still up to date? That is what symposium of the German Society for Statutory Health Insurance Physicians was all about.
And now, gentlemen, I wish you all good holidays! ”After the closing remarks by the State Secretary of the Interior, Clemens Delbrück, at 9:30 in the evening the recorder in the Reich Ministry of the Interior finally finished work on December 23, 1913. Previously, the representatives of the doctors and health insurance companies signed the contract with their almost 400-page verbatim protocol, which, as the “Berlin Agreement” 100 years ago, marked the beginning of joint self-government.
"That the regulation, as it was agreed today, may prove to be blessing for health insurers and doctors in the long run, "said the representative of the company health insurance funds, Councilor of Justice Konrad Wandel, when the contract was signed in the evening. The chairman of the German Medical Association, Medical Councilor Hugo Dippe, paid tribute to the services of the state mediators: “I think I am speaking on behalf of everyone, if I ask you not to part, before we thank the gentlemen from the ministries and especially Excellency Delbrück our deepest thanks for the fact that he brought us together and, through his excellent management of the negotiations, made it possible for us to come to such an unexpectedly favorable result. "
In fact, government intervention was required to get doctors and health insurance companies on the path of shared responsibility for the medical care of the insured. Before that, with the expansion of the statutory health insurance introduced in 1883 to include more and more sections of the population, the tensions between doctors and health insurers had steadily increased. The health insurance companies were increasingly able to conclude contracts with doctors on their own terms. The health insurance companies were only able to counter the growing demand power of the health insurance companies with the founding of the "Association of Doctors in Germany for the Protection of Their Economic Interests", later the Hartmannbund, in 1900.
The years before the Berlin Agreement were marked by Series of medical strikes. A Reich-wide strike was announced for the beginning of 1914 - reason enough for the Interior Ministry to vigorously advocate negotiated solution. The Berlin Agreement ended the licensing autonomy of the health insurance funds and transferred this to contract and registry committees with equal representation. At least one doctor was permitted for every 1,350 insured persons.The Berlin Agreement meant an important step towards the collective contract system and the associated security mandate of the Association of Statutory Health Insurance Physicians (KVen) for outpatient care. This collective bargaining structure was lashed down by ordinance in 1931; The statutory health insurance law based on it from 1955 created the legal basis that has essentially continued to this day.
Where is the journey going?
The collective bargaining system with the security order for the KVs is increasingly being called into question. A dangerous development, says Dr. med. Leonhard Hansen, former chairman of KV Nordrhein, today family doctor in Alsdorf. Because: "Neither rigid regulation by the state nor the organization of the health care system according to the rules of the market is superior to corporate cooperation," he states in position paper presented at the symposium "100 Years of the Berlin Agreement - Ensuring Outpatient Medical Care in the 21st Century. Century "of the German Society for Statutory Health Insurance Physicians Law on November 19th in Berlin.
For Hansen, the future of joint self-administration is inseparably linked to the design and further development of the security mandate. But: “This eroded in continuation of the stronger interference of the state since the 90s of the last century. The core function of the KVs was calculated in disastrous real-world experiment and was carelessly damaged. ”Hansen concludes, politics must guarantee the instruments that KVs need to fulfill their security mandate. This included, among other things, comprehensible competition regime for collective and selective contracts and an option to participate in all types of contracts relevant to care. But Hansen also appeals to doctors to counter existing undesirable developments and disincentives with the necessary consistency. Among other things, he includes the “dynamics of outpatient services in connection with questionable indications” and “the growing provision of lucrative private services for GKV insured persons”. Hansen recommended to all those involved "more responsible ethical action in the sense of Max Weber as central prerequisite for assuming overall responsibility for the - often rather symbolically endeavored - patient wellbeing". 8106434dcd966e4e84b762fbdb108767.png ">
Where is the journey going?
The collective bargaining system with the security order for the KVs is increasingly being called into question. A dangerous development, says Dr. med. Leonhard Hansen, former chairman of KV Nordrhein, today family doctor in Alsdorf. Because: "Neither rigid regulation by the state nor the organization of the health care system according to the rules of the market is superior to corporate cooperation," he states in position paper presented at the symposium "100 Years of the Berlin Agreement - Ensuring Outpatient Medical Care in the 21st Century. Century "of the German Society for Statutory Health Insurance Physicians Law on November 19th in Berlin.
For Hansen, the future of joint self-administration is inseparably linked to the design and further development of the security mandate. But: “This eroded in continuation of the stronger interference of the state since the 90s of the last century. The core function of the KVs was calculated in disastrous real-world experiment and was carelessly damaged. ”Hansen concludes, politics must guarantee the instruments that KVs need to fulfill their security mandate. This included, among other things, comprehensible competition regime for collective and selective contracts and an option to participate in all types of contracts relevant to care. But Hansen also appeals to doctors to counter existing undesirable developments and disincentives with the necessary consistency. Among other things, he includes the “dynamics of outpatient services in connection with questionable indications” and “the growing provision of lucrative private services for GKV insured persons”. Hansen recommended to all those involved "more responsible ethical action in the sense of Max Weber as central prerequisite for assuming overall responsibility for the - often rather symbolically endeavored - patient wellbeing". 8106434dcd966e4e84b762fbdb108767.png ">
"The clear majority of health insurance companies very much appreciate the advantages of joint self-administration and the KV system," emphasized Johann-Magnus von Stackelberg, deputy chairman of the National Association of Statutory Health Insurance Funds. Joint self-administration is still model with promising future. Whether it is possible to ensure medical care in rural areas is kind of yardstick for him for the future viability of the collective agreement. Here one must take into account the needs of the next generation of doctors for new work-life balance; they don't even think about settling down as single specialist anywhere in the area. Together with politicians, it is matter of developing regulatory model for employed doctors and for opening up hospitals to outpatient care. Such an order model, which also safeguards the KVs' right to life, is overdue.
" We as KV have formally the security order, doctors on To get land, but we are not in position to compensate for the lack of attractiveness of an area, ”remarked Mark Barjenbruch, CEO of KV Lower Saxony. He referred to various projects that his KV had initiated in underserved regions. If you want to attract young doctors to the branch, you have to offer them an environment in which they enjoy working. “The fish has to like the bait, not the angler - this is also the case with the security question.” A reasonable fee could be discussed for long time - “if you can't find one for it, you will have to add something to the initial situation for the prospective doctors to improve". With the countless legal regulations of the past few years, the security order was also creeping out. KV Lower Saxony now has hardly any room for maneuver of its own.
Like von Stackelberg and Barjenbruch, Cornelia Prüfer-Storcks, Senator for Health in Hamburg, spoke in favor of the Receipt of collective agreements in outpatient care. “I'm fan of self-management, but sometimes I feel like I'm one of the last. Criticism is also increasing in politics.“Johann-Magnus von Stackelberg, board member of the National Association of Statutory Health Insurance Funds. Photos: Georg J. Lopata
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