The law governing the regulation of doctors and health insurers determined the structure of medical care in Germany for decades.
On July 7th and 8th, 1955, the approval of the Bundestag and Bundesrat to the law on statutory health insurance physicians ended the longstanding dispute over the regulation of relationships between doctors and health insurance companies. With its publication in the Federal Law Gazette on August 19, 1955, the new law came into force 60 years ago. It was also the legal basis for the National Association of Statutory Health Insurance Physicians (KVen) and the National Association of Statutory Health Insurance Physicians in the form of public corporations. The law signified an important professional political success for the resident statutory health insurance physicians, which could be enforced against diverse opposition.
Yes why was new law regulating the relationship between doctors and health insurance companies necessary at all? After 1945, health care provided by statutory health insurance providers continued to function in the three western zones, initially on the basis of the agreements made between doctors and health insurance companies in 1931/32. However, after the end of the war there was no longer the Reich Committee, which was made up of doctors and health insurance companies and was the legally legitimized central authority for regulating the contractual relationships between associations of statutory health insurance physicians and health insurance companies. wanted to reach fee agreements that were disadvantageous for them, dependent on voluntary concessions from the health insurance companies. A fundamental reform that took into account the current conditions of statutory health insurance - increased morbidity, medical progress or the expansion of the proportion of the population with statutory health insurance - did not seem possible on this basis. That is why Ludwig Sievers and Karl Haedenkamp, the two decisive protagonists of medical professional policy in the first post-war decade, have been working hard since 1948 to establish an independent health insurance organization at the interzonal level, which should above all aim for new legal regulation.
Quite but it didn't work as quickly as initially hoped.
The law governing the regulation of doctors and health insurers determined the structure of medical care in Germany for decades.
On July 7th and 8th, 1955, the approval of the Bundestag and Bundesrat to the law on statutory health insurance physicians ended the longstanding dispute over the regulation of relationships between doctors and health insurance companies. With its publication in the Federal Law Gazette on August 19, 1955, the new law came into force 60 years ago. It was also the legal basis for the National Association of Statutory Health Insurance Physicians (KVen) and the National Association of Statutory Health Insurance Physicians in the form of public corporations. The law signified an important professional political success for the resident statutory health insurance physicians, which could be enforced against diverse opposition.
Yes why was new law regulating the relationship between doctors and health insurance companies necessary at all? After 1945, health care provided by statutory health insurance providers continued to function in the three western zones, initially on the basis of the agreements made between doctors and health insurance companies in 1931/32. However, after the end of the war there was no longer the Reich Committee, which was made up of doctors and health insurance companies and was the legally legitimized central authority for regulating the contractual relationships between associations of statutory health insurance physicians and health insurance companies. wanted to reach fee agreements that were disadvantageous for them, dependent on voluntary concessions from the health insurance companies. A fundamental reform that took into account the current conditions of statutory health insurance - increased morbidity, medical progress or the expansion of the proportion of the population with statutory health insurance - did not seem possible on this basis. That is why Ludwig Sievers and Karl Haedenkamp, the two decisive protagonists of medical professional policy in the first post-war decade, have been working hard since 1948 to establish an independent health insurance organization at the interzonal level, which should above all aim for new legal regulation.
Quite but it didn't work as quickly as initially hoped.Although the existing statutory health insurance associations in the three western zones merged in October 1948 on the fringes of the first post-war doctors' conference in Stuttgart to form the working group of the West German state offices of statutory health insurance associations, at the beginning of 1949 first draft law supported by the newly formed statutory health insurance self-administration failed due to the objection of the Allied dual power control office. The occupation powers decided that the handling of this matter should be left to the decision of the Federal Parliament, which will meet shortly.
With the election victory of bourgeois conservative coalition after 1949, the opportunity seemed favorable to more than the framework law that had been aimed for few months earlier. which only provided for the old Reich Committee in new legal guise to be implemented. A proposal submitted by Ludwig Sievers aimed to establish self-administration by statutory health insurance physicians, in particular to transfer the mandate to conclude contracts with the substitute health insurance funds and to enable various types of remuneration (flat-rate per case, flat-rate per capita or remuneration according to individual service).
The statutory health insurance physicians were satisfied with the draft law presented by the Federal Ministry of Labor in 1951. "I have looked through the bill very carefully and I am of the opinion that, if this bill becomes law, we have every reason to be happy," said Ludwig Sievers, chairman of the Association of Statutory Health Insurance Physicians, in June 1951. The medical negotiators had largely achieved agreement with the health insurance associations in the preparatory work on the draft law. Internal medical quarrels in particular caused long delay - the Hartmannbund was outraged by the legally stipulated arbitration bodies and found itself at the mercy of the dictates of the supervisory authority without the right to strike - and objections from the hospital operators - they defended themselves against being excluded from outpatient medical care.
The Federal Ministry of the Interior adopted the position of the hospital society, according to which the hospitals should be granted direct agreements with the health insurance companies on the billing of outpatient services. Robert Pferdmenges, influential advisor to Konrad Adenauer, wrote to the Chancellor for the concerns of the hospitals: The planned new legal regulation would lead to "reduction of the position of the hospitals, which was not enforced even by National Socialism despite several attempts by the medical profession".Although the existing statutory health insurance associations in the three western zones merged in October 1948 on the fringes of the first post-war doctors' conference in Stuttgart to form the working group of the West German state offices of statutory health insurance associations, at the beginning of 1949 first draft law supported by the newly formed statutory health insurance self-administration failed due to the objection of the Allied dual power control office. The occupation powers decided that the handling of this matter should be left to the decision of the Federal Parliament, which will meet shortly.
With the election victory of bourgeois conservative coalition after 1949, the opportunity seemed favorable to more than the framework law that had been aimed for few months earlier. which only provided for the old Reich Committee in new legal guise to be implemented. A proposal submitted by Ludwig Sievers aimed to establish self-administration by statutory health insurance physicians, in particular to transfer the mandate to conclude contracts with the substitute health insurance funds and to enable various types of remuneration (flat-rate per case, flat-rate per capita or remuneration according to individual service).
The statutory health insurance physicians were satisfied with the draft law presented by the Federal Ministry of Labor in 1951. "I have looked through the bill very carefully and I am of the opinion that, if this bill becomes law, we have every reason to be happy," said Ludwig Sievers, chairman of the Association of Statutory Health Insurance Physicians, in June 1951. The medical negotiators had largely achieved agreement with the health insurance associations in the preparatory work on the draft law. Internal medical quarrels in particular caused long delay - the Hartmannbund was outraged by the legally stipulated arbitration bodies and found itself at the mercy of the dictates of the supervisory authority without the right to strike - and objections from the hospital operators - they defended themselves against being excluded from outpatient medical care.
The Federal Ministry of the Interior adopted the position of the hospital society, according to which the hospitals should be granted direct agreements with the health insurance companies on the billing of outpatient services. Robert Pferdmenges, influential advisor to Konrad Adenauer, wrote to the Chancellor for the concerns of the hospitals: The planned new legal regulation would lead to "reduction of the position of the hospitals, which was not enforced even by National Socialism despite several attempts by the medical profession".The concerns raised led to temporary standstill in the further treatment of the draft law regulating the relationship between doctors and health insurance companies. The medical profession entered the public debate on the matter with an extraordinary German Doctors' Conference in November 1952.
The extent to which this contributed to defusing the conflict with the hospitals cannot be precisely determined. As result, an agreement was reached with the German Hospital Society, according to which the leading hospital doctors could be involved in medical care after referral. Hospitals as independent contractual partners of the health insurance companies for outpatient services were no longer up for discussion. The passages that allowed the health insurers to operate their own facilities had also disappeared from the draft law. The fact that the health insurers should not be able to guarantee outpatient medical care themselves if contractual arrangement with the statutory health insurance doctors does not materialize was one of the main objections raised by the health insurances against the draft law. They saw themselves meanwhile degraded to mere paying agents. The new controversy led to the fact that no decision was made on the draft law in the first legislative period, but this did not prevent the KVen working group from renaming itself to the National Association of Statutory Health Insurance Physicians in 1953.
After the federal election in 1953, everything went relatively fast. The bill introduced by the government factions in May 1954 was swiftly passed through the relevant committees. In particular, the medical representatives of all parties, in coordination with the medical professional associations, ensured that bill was finally voted on, which largely took into account the interests of the statutory health insurance physicians. Despite opposition from various quarters, the political bodies succeeded in getting legal text through the years 1949 to 1955, which brought the associations of statutory health insurance physicians monopoly on outpatient medical care and, due to its fee provisions, the prerequisites for the subsequent above-average increase in income of established doctors. It was the result of clever negotiation and lobbying strategy by the medical professional representatives with clear advantages over the health insurance companies and hospitals.The concerns raised led to temporary standstill in the further treatment of the draft law regulating the relationship between doctors and health insurance companies. The medical profession entered the public debate on the matter with an extraordinary German Doctors' Conference in November 1952.
The extent to which this contributed to defusing the conflict with the hospitals cannot be precisely determined. As result, an agreement was reached with the German Hospital Society, according to which the leading hospital doctors could be involved in medical care after referral. Hospitals as independent contractual partners of the health insurance companies for outpatient services were no longer up for discussion. The passages that allowed the health insurers to operate their own facilities had also disappeared from the draft law. The fact that the health insurers should not be able to guarantee outpatient medical care themselves if contractual arrangement with the statutory health insurance doctors does not materialize was one of the main objections raised by the health insurances against the draft law. They saw themselves meanwhile degraded to mere paying agents. The new controversy led to the fact that no decision was made on the draft law in the first legislative period, but this did not prevent the KVen working group from renaming itself to the National Association of Statutory Health Insurance Physicians in 1953.
After the federal election in 1953, everything went relatively fast. The bill introduced by the government factions in May 1954 was swiftly passed through the relevant committees. In particular, the medical representatives of all parties, in coordination with the medical professional associations, ensured that bill was finally voted on, which largely took into account the interests of the statutory health insurance physicians. Despite opposition from various quarters, the political bodies succeeded in getting legal text through the years 1949 to 1955, which brought the associations of statutory health insurance physicians monopoly on outpatient medical care and, due to its fee provisions, the prerequisites for the subsequent above-average increase in income of established doctors. It was the result of clever negotiation and lobbying strategy by the medical professional representatives with clear advantages over the health insurance companies and hospitals.
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