Zur Kommerzialisierung der Krankenversorgung - solidarische Alternativen sind möglich!

Das vorliegende Diskussionspapier ist die erweiterte and aktualisierte Fassung des Kapitels „Neoliberalismus und Arzt-Patient-Beziehung“ meines Buches „Zur sozialen Anatomie des Gesundheitswesens. Neoliberalismus und Gesundheitspolitik in Deutschland“ (Frankfurt 2005). Es geht dabei um die Ökonomisierung bzw. Kommerzialisierung eines sozialen Bereiches, der davor lange Zeit verschont wurde. Der Einfluss von Markt und Wettbewerb auf die Arzt-Patient- Beziehung werden beschrieben und analysiert sowie auf daraus folgende wichtige Veränderungen hingewiesen. Dabei zeigt sich, dass der Patient zunehmend zum Kunden wird und der Arzt immer intensiver unternehmerisch zu denken hat. Der Ermessensspielraum für ärztliche Entscheidungen, von Indikationsstellungen und therapeutischen Interventionen, werden davon nicht unerheblich berührt. Daraus ergeben sich ethische Aspekte, die schon vor einigen Jahrzehnten von der „kritischen Medizin“ beklagt wurden. Gesundheit wird hier als Menschenrecht gesehen. Als Gegenmodell zur um sich greifenden Kommerzialisierung gelten neue Formen der Versorgung, die auf der Basis von Solidarität beruhen.This discussion paper is the enlarged and updated version of the chapter „Neoliberalism and Doctors-Patient-Relationship” in my book "Zur sozialen Anatomie des Gesundheitswesens. Neoliberalismus und Gesundheitspolitik in Deutschland“ (Frankfurt a. M. 2005). It takes a critical look at the process at economising and commercialisation of a social field which was exempted for some time. The impact of market and competition on the relation between physicians and patients is described and analysed. Important changes will be stressed. One is that the patients will be more and more in the position of a customer and the physician has to act and think more and more in categories of an entrepreneur. It touches the discretionary decisions of physicians for medical indications and therapeutic interventions with important ethical aspects. Health is seen as a human right. The alternative to the process of commercialisation of medical institutions are forms of care which are based on the principle of solidarity

Novas técnicas, medicina do trabalho e saúde

O artigo comenta os efeitos para a saúde e aspectos sociais relacionados à introdução das modernas tecnologias microeletrônicas no interior dos processos de trabalho, particularmente na República Federal da Alemanha. O autor faz considerações sobre alguns limites teóricos da Medicina do Trabalho para analisar e prevenir os problemas decorrentes desse processo.The present article deals with the health effects and social aspects associated with the introduction of modern microelectronic technologies within work processes, particularly in the Federal Republic of Germany. The author makes considerations on some theoretical limitations of Occupational Medicine in order to analyse and avert problems resulting from these processes

The nature of health care: commodification versus solidarity

Health and sickness are deeply rooted in the conditions of life, the conditions of work and the social relations of society. Health care is similarly socially embedded. And just as health or sickness are never purely individual matters, nor is health care. Dealing with the origins of sickness and caring for the sick are tasks for society. There is a collective and public dimension, which goes by the label of ‘health policy’. There are political issues which are more important, but in recent years, when almost all countries have been confronted by the processes of globalisation, deregulation and privatisation, health care has been high on the political agenda.  Elements of a universal healthcare system already exist in many countries, in developing countries as well as in the rich welfare states. The elements are not identical, because they have different histories. They confront different difficulties. They vary in what services are covered completely, covered partially, or not covered at all. But they all are based on different forms of solidarity. And it is from that -- from the meaning of solidarity -- that we have to see the future of health care. Solidarity was and is the alternative to neo-liberal commercialisation. Human health care is not possible without solidarity

State and health

This paper examines the health functions of the state in the F.R.G. in their historical, political and socio-economic inter-relationships. The main focus is on the antagonistic interests of the social classes. Special emphasis is placed on an analysis of the health political state intervention of 1974 which marked the beginning of the far-reaching economic crisis. There were serious restrictions placed on utilization such as co-payments and other interventions: commercialization; privatization; individualization; and the rationalization of public services. Moreover, as the data show, there have been massive transferences within the public service system at the expense of the socially insured.

Zur Einkommensentwicklung bei niedergelassenen Ärzten

Gerlinger T, Deppe H-U. Zur Einkommensentwicklung bei niedergelassenen Ärzten. Frankfurt a. M.; 1994

Ärzte, Geld und Politik. Kassenärztliche Handlungsstrategien und individuelle Leistungsanreize nach der Einführung der Praxisbudgets

Gerlinger T. Ärzte, Geld und Politik. Kassenärztliche Handlungsstrategien und individuelle Leistungsanreize nach der Einführung der Praxisbudgets. In: Deppe H-U, ed. Medizin und wirtschaftlicher Wettbewerb. Frankfurt a. M.; 1998: 51-65