How freely can doctor still choose his therapy today in view of increasing economic pressures? Doctors, representatives of self-administration and other experts discussed this at this year's Internist Day.
Independent medical activity is hindered at all levels by economic requirements, ”said the President of the Federal Association of German Internists (BDI), Dr. med. Wolfgang Wesiack, in his opening speech for the 4th German Internist Day in Berlin. "The doctor has been made an assistant to these economic requirements and has to justify the rationing decisions to his patient himself."
The fact that both residents and hospital doctors are affected by this was reflected in the various discussions at the Internist Day. "A typical example from outpatient care is the service catalog, which is defined in the Uniform Evaluation Standard (EBM)," explained Dr. med. Hans-Friedrich Spies, 2nd Vice President of the BDI. For economic reasons, new treatment methods are only included in the EBM with delay. This would lead to major differences between the outpatient and the inpatient catalog of services, which led to treatment discontinuities during the transition from hospital to practice.
In the clinics it is no better: "The economic constraints of hospital administration have to be implemented by the employed doctors," criticized Spies. Admission and discharge dates are largely set according to the rules of the DRG system. Spies therefore advocates more attending physicians at the hospitals: "A contract doctor could better defend himself against such requirements, since he does not have direct superior who gives him economic requirements."
Prof. Dr. med. Hans-Fred Weiser, President of the Association of Leading Hospital Doctors in Germany, blames political constraints for the problem. "We have to deal with an average of four laws or ordinances each year, all of which aim to keep costs down." However, structural changes have so far been missing. Politicians are not the only ones responsible for this. “We also have to propose our own solutions,” Weiser stated. “However, it is difficult for me to find real willingness to innovate and find solutions in self-administration and professional associations.
How freely can doctor still choose his therapy today in view of increasing economic pressures? Doctors, representatives of self-administration and other experts discussed this at this year's Internist Day.
Independent medical activity is hindered at all levels by economic requirements, ”said the President of the Federal Association of German Internists (BDI), Dr. med. Wolfgang Wesiack, in his opening speech for the 4th German Internist Day in Berlin. "The doctor has been made an assistant to these economic requirements and has to justify the rationing decisions to his patient himself."
The fact that both residents and hospital doctors are affected by this was reflected in the various discussions at the Internist Day. "A typical example from outpatient care is the service catalog, which is defined in the Uniform Evaluation Standard (EBM)," explained Dr. med. Hans-Friedrich Spies, 2nd Vice President of the BDI. For economic reasons, new treatment methods are only included in the EBM with delay. This would lead to major differences between the outpatient and the inpatient catalog of services, which led to treatment discontinuities during the transition from hospital to practice.
In the clinics it is no better: "The economic constraints of hospital administration have to be implemented by the employed doctors," criticized Spies. Admission and discharge dates are largely set according to the rules of the DRG system. Spies therefore advocates more attending physicians at the hospitals: "A contract doctor could better defend himself against such requirements, since he does not have direct superior who gives him economic requirements."
Prof. Dr. med. Hans-Fred Weiser, President of the Association of Leading Hospital Doctors in Germany, blames political constraints for the problem. "We have to deal with an average of four laws or ordinances each year, all of which aim to keep costs down." However, structural changes have so far been missing. Politicians are not the only ones responsible for this. “We also have to propose our own solutions,” Weiser stated. “However, it is difficult for me to find real willingness to innovate and find solutions in self-administration and professional associations.“
The BDI does not believe that the situation will change with the upcoming Supply Structure Act (VStG). "A sustainable improvement in the care situation for patients, targeted fight against the shortage of doctors and further development of the hospital sector cannot be achieved with the current draft law," explained Wesiack. However, the introduction of special medical care area is positive: "This is significant improvement on the existing regulation," he stated. The VStG provides that both resident doctors and hospitals can offer the diagnosis and treatment of special clinical pictures as service if they meet the necessary quality requirements. "The old regulation of § 116 b SGB V is one-sided and only allows the hospitals to participate in outpatient care," said Wesiack. Residents would now also benefit from the new regulation: “This is step forward.”
“We also welcome the fact that there is to be an individual service fee for specialist medical care and no quantity restriction,” he explained. So far, however, it is unclear where the money will come from. According to Wesiack, the area of specialist medical care accounts for around 16 percent of all billed services. He expects that the VStG will increase the number of benefits. "The expansion of supply area is also an improvement in supply," emphasized Wesiack. “That also has to be paid for.” That is why the money cannot - as many fear - simply be taken from the pot of specialist medical care.
Dr. rer. nat. Marc Meißner
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