Berlin - With the Supply Structure Act (VStG), the federal government wants to combat the shortage of doctors, among other things. The (KBV) showed that this is urgently needed at press seminar on Tuesday evening. The average age of contract physicians has risen from 46.6 years in 1993 to 52.2 years last year, explained KBV CEO Andreas Köhler. The proportion of doctors over 60 has increased from 6.7 percent to 13.5 percent in the same period. "By 2020, 30,705 general practitioners, specialists as well as senior and chief physicians at hospitals will retire from curative medicine due to age, and by 2020 even 66,830," said Köhler. With the currently missing doctors, the KBV expects replacement requirement of 74,000 curative doctors by 2020. The problem is particularly big in the eastern German states, said Köhler. In spring 2011 there was supply rate of less than 100 percent in 40 planning districts, and even below 75 percent in one planning district. A total of 271 general practitioners were missing there.
"But not only the East is affected by the shortage of doctors," emphasized the KBV boss. Many districts are also undersupplied in the northern German states, especially in Lower Saxony. In Schleswig-Holstein, Hamburg, Bremen, Lower Saxony and Westphalia-Lippe, 238 family doctors were missing in the spring of 2011.
“The dilemma is that the number of contract physicians is increasing - since 2004 2.7 percent from 116,990 to 120,153. But the question is: where are we growing? ”Said Köhler. "We are not growing with the so-called planned doctor groups, which are recorded by the requirement planning, but with the non-planned doctor groups, to which fewer than 1,000 doctors belong." These are, for example, molecular geneticists or transfusion specialists. But the number of doctors in primary care is decreasing. Köhler also commented on the report prepared by Prognos AG on behalf of the National Association of Statutory Health Insurance Funds, according to which 12,000 doctor's seats could be bought up. According to this, the greatest buying potential lies primarily with psychotherapists. According to Prognos, around 5,000 practices could be closed.
This report did not take into account some important aspects, criticized Köhler. For example, the ratios in psychotherapeutic care in 1999 were set far too low to reflect today's needs. In rural areas, the ratios were already too low back then. In addition, Prognos did not take into account that many cities also care for patients from the surrounding area. In Weiden in the Upper Palatinate, for example, this co-provision is 64.2 percent, in Koblenz 60 percent and in Würzburg 58.9 percent. A higher number of doctors in the cities is therefore necessary in order to be able to care for the surrounding area. "Basically we are not against buying up doctors' seats, that is already practiced," said Köhler. “But you have to analyze carefully beforehand whether the relevant practice is still needed for the supply.” The KBV also commented on the costs that the statutory health insurance will have to face as result of the Supply Structure Act. In June, the National Association of Statutory Health Insurance Funds warned of additional costs of 2.7 billion euros, because the graduation of the remuneration should in future be based on the services provided in the previous year and the entire fee pot would increase every year.
The Federal Ministry of Health immediately denied it and Köhler now also said that such an elimination of so-called fee-effective limitation payments for the assessment of the total remuneration was not provided for in the law now and not in earlier drafts.
The KBV is therefore only expecting cost increase of 277 million euros in the years 2012 to 2014 as result of the VStG. These arise from the surcharge for services that are particularly worthy of support from the structural fund and from the extra-budgetary total remuneration.
Depending on whether convergence of remuneration is still included in the Supply Structure Act and how the outpatient specialist medical care is structured, more could be Additional costs. However, the additional costs cannot be estimated, especially for specialist medical care.