The migration of doctors to and from Germany

Aim: To analyse the role of Germany in the context of the strong international migration of doctors. In doing so, the migration of German doctors abroad and foreign doctors to Germany is qualitatively and quantitatively presented. Subjects and methods: The annual statistical reports from the country's medical associations given to the Federal Medical Association were investigated on migratory movements. Furthermore, a survey on how many German doctors are working in these countries was done within relevant organisations in some European countries and the US. Results: Germany is affected by an international migration of doctors in two directions. German doctors are emigrating and as well foreign doctors are immigrating. The exchange is not balanced, Germany loses more doctors every year to foreign countries than it gains through immigration. Discussion and conclusions: The increasing emigration of German doctors reinforces the shortage of doctors in Germany. In addition, the functioning of the German health system increasingly depends on the immigration of foreign doctors

Herausforderungen an die Gesetzliche Krankenversicherung

Die Ausgabendämpfungspolitik der letzten zwanzig Jahre hat die Ursachen der Kostenexplosion nicht tangiert, daher ist der Beitragssatz in der Gesetzlichen Krankenversicherung weiterhin kontinuierlich angestiegen. Als letztendliche Gründe für die Ausgabendynamik und zukünftige Herausforderungen an die GKV schälen sich der demographische Wandel und der medizinische Fortschritt heraus. In Berechnungen wird dargelegt, daß der Beitragssatz in der GKV aufgrund der doppelten Altersdynamik im Jahre 2030 bei gleichen Versorgungsansprüchen deutlich über 20% liegen wird. Weiter zeigt sich: Durch den Fortschritt werden die Möglichkeiten der Medizin ständig erweitert. Diese Explosion des Machbaren geht mit Ausgabensteigerungen einher. Der medizinische Fortschritt löst eine Fortschritts-Ausgaben-Spirale aus: Er verlängert die (Rest-) Lebenserwartung der Menschen und erhöht damit die Aufwendungen im Gesundheitswesen, da die Krankheitskosten mit zunehmendem Alter progressiv anwachsen. Permanent werden neue medizinische Wohltaten entwickelt, deren Finanzierbarkeit allerdings an Grenzen stößt. Die Rationierung medizinischer Leistungen ist unausweichlich, soll die GKV bezahlbar bleiben.Gesetzliche Krankenversicherung, demographischer Wandel, medizinischer Fortschritt, Rationierung

Gesundheitswesen am Scheideweg

Das Gesundheitssystem gerät durch steigende Ausgaben in der Gesetzlichen Krankenversicherung zunehmend unter Druck. Welche Rolle spielt dabei der medizinische Fortschritt? --

Waiting times in the ambulatory sector - the case of chronically Ill patients

Aims: First, the influence of determinants on the waiting times of chronically ill patients in the ambulatory sector is investigated. The determinants are subdivided into four groups: (1) need, (2) socio-economic factors, (3) health system and (4) patient time pressures. Next, the influence of waiting times on the annual number of consultations is examined to assess whether the existing variation in waiting times influences the frequency of medical examinations. The waiting times of chronically ill patients are analysed since regular ambulatory care for this patient group could both improve treatment outcomes and lower costs. Data sources: Individual data from the 2010 Representative Survey conducted by the National Association of Statutory Health Insurance Physicians (KBV) together with regional data from the Federal Office of Construction and Regional Planning. Study design: This is a retrospective observational study. The dependent variables are waiting times in the ambulatory sector and the number of consultations of General Practitioners (GPs) and specialist physicians in the year 2010. The explanatory variables of interest are ‘need’ and ‘health system’ in the first model and ‘length of waiting times’ in the second. Negative binomial models with random effects are used to estimate the incidence rate ratios of increased waiting times and number of consultations. Subsequently, the models are stratified by urban and rural areas. Results: In the pooled regression the factor ‘privately insured’ shortens the waiting time for treatment by a specialist by approximately 28% (about 3 days) in comparison with members of the statutory health insurance system. The category of insurance has no influence on the number of consultations of GPs. In addition, the regression results stratified by urban and rural areas show that in urban areas the factor ‘privately insured’ reduces the waiting time for specialists by approximately 35% (about 3.3 days) while in rural areas there is no evidence of statistical influence. In neither of the models, however, does the waiting time have a documentable effect on the number of consultations in the ambulatory sector. Conclusions: In our random sample, characteristics of the health care system have an influence on the waiting time for specialists, but the waiting time has no documentable effect on the number of consultations in the ambulatory sector. In the present analysis this applies to consultations of both GPs and specialists. Nevertheless, it does not rule out the possibility that the length of waiting times might influence the treatment outcomes of certain patient populations

Zur Einkommenselastizität der Nachfrage nach Gesundheitsleistungen - Eine Analyse von Querschnittsdaten

Auf der Basis von Daten der Einkommens- und Verbrauchsstichprobe 1993 wird die Einkommenselastizität der Nachfrage nach Gesundheitsleistungen geschätzt. Dabei werden für privat und gesetzlich Krankenversicherte getrennte Schätzungen durchgeführt. Es zeigt sich, dass die Einkommenselastizität der Nachfrage bei geringen und mittleren Einkommen größer als eins und nur für Spitzenverdiener kleiner als eins ist. Implikationen dieses Ergebnisses für die Gesundheitspolitik werden diskutiert.

Eine Systematisierung des Rationalisierungsproblems in der Medizin

Dieser Beitrag beschäftigt sich systematisch mit dem Komplex der Rationalisierung medizinischer Leistungen. Als Ergebnis ergibt sich, daß explizite Rationierung der impliziten vorzuziehen ist und die Rationierungen möglichst ex ante auf der Makro-Ebene erfolgen sollten, ohne Gefährdung identifizierbarer Menschenleben. Die Bestimmung von Ex-post-Auswahlkriterien ist dennoch erforderlich, allerdings außerordentlich schwierig. Medizinische, ethische und ökonomische Kriterien lassen sich nicht simultan erfüllen. Die Darstellung der ökonomischen Ansätze zur Bewertung von Leben und Gesundheit zeigt, daß diese aufgrund verschiedener Defizite nur als Entscheidungshilfeund Anregung dienen können. Schließlich ergibt sich, daß Rationierungen auf der Makro-Ebene den bestehenden Trade-off zwischen schwacher und starker Rationierung verschärfen.Gesundheitsökonomik, Rationierung

Planning medical care for actual need

Aim: When it came into force on 1 January 1993, the Health Structure Act brought about far-reaching changes in the German health system by completely reorganising needs-related planning for office-based medical care. The experience to date suggests that needs-related planning is having an effect. Since the law came into effect, the increase in the number of doctors has clearly levelled off, and in certain fields the trend can even be said to have been reversed. Indeed, needs-related planning will in future have to address a completely new issue, one that only a few years ago was considered inconceivable: a looming lack of doctors. It is precisely in this context that needs-related planning, an arrangement conceived when the number of doctors was rising, can be seen to have strategic flaws. It has now become clear that the data (population, number of doctors) and information on structures (geographical planning units) drawn on in needs-related planning to indicate the degree of provision are unsuitable for ascertaining the need for, and controlling the supply of, office-based medical care. Indeed, the current needs-related planning hardly justifies its name. Subjects and methods: There is a need for genuinely strategic planning that, rather than measuring the status quo in isolation, takes due heed of likely future trends in such factors as population and the number of doctors. Results and conclusion: The reversal of the trend from over- to undersupply of medical care has brought about an increasing scarcity of points of access. If the Associations of Statutory Health Insurance Physicians are to meet their legal commitment to provide universal medical coverage, it is essential that an analysis of the relationships within the care supply network be carried out. A potential solution to this problem is offered by “regional studies interaction models”, which model the physical accessibility and convenience for patients of supplier locations (here: office-based physicians) and the response of the demand side (here: the patients) to the existing geographical constellations