1989/2009 - 20 years of German unity: German-German health policy in the unification process (I)
=" img alt " images / a5e5f4a7c0b350b2588710650023fb2a.png ">For short time, lot seemed possible. However, faster than most expected, the German structures of outpatient medical care were transferred to the new federal states. Forty years of different social and health policies in the Federal Republic and the GDR were most evident in outpatient medical care. Here there were the opposite concepts of freelance doctors in individual practices on the one hand and polyclinics with employed doctors on the other. The structures of outpatient medical care had already been redesigned in the Soviet Zone of Occupation (SBZ) and subsequently by the state and party leadership of the GDR, partly for pragmatic, but especially for social considerations (). We do not want to analyze the advantages and disadvantages of the two health systems here. Just this much: the advantages of the GDR health system undoubtedly included the close interlinking of outpatient and inpatient care, the emphasis on the prevention and early detection of diseases, and the unity of care, treatment and aftercare. The organizational structures of outpatient medical care, especially the polyclinics, are to be classified in this context. The number of resident doctors in the GDR has continuously decreased and their average age has increased steadily. In contrast, the expansion of state and company polyclinics and outpatient clinics as well as state medical practices was pushed ahead. In the autumn of 1989, the majority of outpatient doctors were therefore employed in the state or company health service, worked in polyclinics, outpatient clinics and in company health care. In addition, part of the outpatient treatment was provided by doctors working in inpatient facilities. At the end of the GDR, however, only tiny fraction was still working in private practice as resident doctor: in 1989 this was 341 of the 20,570 outpatient doctors (). The crisis in the East German healthcare system in 1989 Already on 11.In August 1989, the SED leadership identified important deficits in an internal analysis of ensuring medical and social care for the population (): labor shortages in hospitals, insufficient capacity in after-work and nursing homes, including 160,000 applicants 20,000 urgent cases, the catastrophic state of the building stock of hospitals, spa facilities and medical research institutes, which endangered or restricted the functionality; medical work was hampered by lack of medicine and medical equipment. It also had to be admitted that the distance to medical equipment had increased in an international comparison. Such critical findings were withheld from the public. Apparently, there was also no discussion with the affected health and social workers. Critical discussions would have disrupted the preparations for the jubilee celebrations for the 40th anniversary of the GDR. During the peaceful revolution, the weaknesses of the health care system were particularly evident in the media and in the public. One remembers, for example, the criticism of the dilapidated buildings of the hospitals and old people's homes, in which old people and people in need of care lived in overcrowded shared rooms. At that time, the sides of the health system that were worth preserving were completely hidden. This media selection obviously had an impact on the basic attitude of the GDR population. It is therefore not surprising that demonstrators nowhere campaigned for the maintenance of polyclinics or outpatient clinics. Discussions about reform within the medical profession, for example in the opposition group Doctors for Peace (), did not reach the public in the stormy autumn of 1989. The crisis in the health care system intensified dramatically in the last months of 1989, and the personnel problems in particular became increasingly serious; because after the fall of the wall, doctors and other medical personnel from the GDR to the Federal Republic continued. In 1989 around 10,000 health and social workers, including around 4,000 doctors and dentists and 4,000 nurses, left the GDR (). Money for health: "It's about lifeblood" The last SED minister for health and social affairs, Klaus Thielmann, wrote several letters to leading GDR and SED officials in November 1989, also to the new SED General Secretary Egon Krenz (). Among other things, he called for an increase in salaries and an increase in material and financial resources for the health service. At the end of November 1989 Thielmann wrote to the new Prime Minister Hans Modrow and repeated his demands.He asked for government spending to be reallocated to the Ministry of State Security and the National People's Army in favor of health and social policy. The share of expenditure on health care in the national income of the GDR was recently five percent; that was too low compared to the western countries, even the Soviet Union. Thielmann also asked for workers from the Ministry for State Security (MfS) and the National People's Army (NVA) to be deployed in the social sector. If his demands for substantial increase in salaries in the health and social services were not met, he threatened to resign. Apparently the Minister found Gehr. As of March 1, 1990, salaries in the health care system were increased significantly (). Thielmann was aware of the particular political explosiveness of the desolate situation in the health system for the reputation of the last SED government. Failing because of health and social services, he wrote to Modrow at the end of January 1990, means losing credibility for policy that is supposed to serve people and protect them from the most elementary benefits. This is about lifeblood. () Thielmann also considered additional expenditures for the health service to be necessary in order to be able to contribute basic positions in the field of health and social policy in contractual community with the Federal Republic and in the cooperation and growing together of the two German states GDR and which must not be lost. This gives us the opportunity, according to Thielmann, to contribute independently: The social principles of our health and social system are undisputed. The exclusion from commercialization in this area is historic achievement. ()
The really radical changes took place in the East after the fall of the wall. Long familiar things soon disappeared. Photos: dpa
Health promotion in the company: Workers desVEB Statron doing exercise during breaks, recorded in September 1976
Last but not least, the GDR company policlinics should ensure that the workers are able to work.Routine examination in the company policlinic of VEB SchwermaschinenbauLauchhammer in July 1974
Cf. Jürgen Wasem, From the state to the health insurance system. An investigation of the transformation process of outpatient medical care in East Germany, Frankfurt / New York, 1997,
Gunnar Winkler (ed.), History of Social Policy of the GDR 1945–1985, Berlin (East) 1989, p. 391.
Cf. Jürgen Wasem, Von from the polyclinic to the statutory health insurance doctor's practice: attempt to reconstruct the decision-making situation of outpatient doctors in eastern Germany. In: Max Planck Institute for Social Research, Cologne 1992/5, p.134.
Cf. Wasem, Vom Staatlichen zum Kassenärztlichen System, p. 48.
Cf. analysis and suggestions on how to continue the party's health policy through higher quality and effectiveness of work medical and social care for the population is ensured in the five-year plan period up to 1995, from 11.8.1989 (BArch, DQ 1, 12097, unpaginated)
Contribution by Herbert Loos to the workshop “Transformation of the health system in the new federal states”, organized by the Hannah Arendt Institute for Research on Totalitarianism in the summer of 2006 in Meißen.
Cf. Gero Neugebauer, "Social Charter" versus "Social Report". Drafts on the wish and reality of the GDR social policy. In: ZParl 21 (1990), pp. 146-8.
Cf. Thielmann to the General Secretary of the Central Committee of the SED and chairman of the State Council of the GDR, November 7, 1989 (BArch, DQ 1, 14919, unpaginated)
Cf. Thielmann to the Lord Mayor of Berlin (Ost ), February 5, 1990 (BArch, DQ 1, 14919, unpaginated)
Thielmann to Modrow, January 21, 1989 (BArch, DQ 1 , 14919, unpaginated)
Cf. Wasem, From the state to the health insurance system, p.21.
Cf. Manfred G. Schmidt, Fundamentals of Social Policy in the DDR. In: History of social policy in Germany since 1945, vol. 1, Baden-Baden 2001, p.750.
Cf. Wasem, From the state to the health insurance system, p. 51
Cf. Health policy and employment policy perspectives of the public services, transport and traffic union (ÖTV), 5.6.1990 (BArch, DQ 1/14222, unpaginated)
Cf. Wasem, From the state to the statutory health insurance system, P. 122f.
Cf. ibid., P. 123.
Cf. Wasem, From the state to the health insurance system, p. 124.
Thielmann to the chairperson of the District Council, February 28, 1990. (BArch, DQ 1, 14919, unpaginated)
Thielmann to the Minister for Labor and Wages, H. Mensch, and those primarily responsible for drafting the Social Charter, March 13, 1990 (BArch, DQ 1, 14919, unpaginated)
See positions of the government of the GDR on basic social rights (BArch, DQ 3, 1884, unpaginated)
Horst Seehofer, “The rotten egg from the round table. Socialists do not learn anything ". In: Bayernkurier from March 17, 1990.
Cf. Federal Ministry for Labor and Social Affairs (ed.), The welfare state unites: To social Unity of Germany - developments and impressions. A recording by Hans-Ulrich Spree, Baden-Baden 1994, p. 36.