Healthcare no future viability?

Healthcare no future viability?

Gloomy future expectations: only 16 percent are convinced that today's care can be maintained - 79 percent expect an increasing two-class medicine

Patients and doctors fear a nursing emergency in Germany and accuse politicians of inaction. At the same time, doctors in particular see an increasing shortage of doctors, especially in the eastern federal states, patients are already reporting limited care. Overall, the Germans rate today's health care system positively - but with clear regional differences: The people in Saxony and Berlin are the most satisfied, Mecklenburg-Western Pomerania and Thuringia are at the bottom, where the shortage of doctors is already clearly noticeable. The population and doctors are pessimistic about future developments and expect increasing cuts. Today, more than a third of doctors have to postpone treatments at least occasionally for cost reasons. These are some of the key findings of the 6th MLP Health Report. The institute for demoscopy Allensbach carried out the representative study on behalf of the financial and wealth consultant MLP with the support of the German Medical Association.

Politicians are doing too little against feared nursing emergencies More than one in two is concerned about their financial security in the event of nursing care. Confidence in statutory nursing care insurance has also declined significantly: More than three quarters are now afraid that the benefits to ensure good nursing care will not be sufficient (2010: 64 percent). At 80 percent, doctors are even more concerned. They have a correspondingly negative opinion of politics: 82 percent of doctors and citizens demand that this must do more for nursing. Large parts of the doctors (46 percent) and the population (43 percent) are skeptical, however, whether politics can at all succeed in ensuring good care for all those in need of care. "Politicians have recently decided to start additional funded coverage," says Dr. Uwe Schroeder-Wildberg, CEO of MLP. “This is a correct step, but it is not enough. The MLP Health Report clearly shows that the citizens would also have supported a care reform that tackled the challenges at the root. ”When faced with the choice, a majority of 43 percent in favor of compulsory supplementary insurance, only 15 percent for an increase of contributions to statutory long-term care insurance. The picture is even clearer among doctors: 72 percent advocate mandatory supplementary long-term care insurance.

Concerns about a shortage of doctors have increased significantly. In particular, doctors are increasingly finding a shortage of doctors: Almost two thirds (2010: 46 percent) already see a problem in this; another 23 percent anticipate this in the future. The results also show a clear east-west difference: in east Germany 69 percent speak of a shortage of doctors in their region, in the west it is only 47 percent. So far, the population has felt the lack of doctors significantly less than the doctors (13 percent), but around one in five reckons with it. Nationwide, people in structurally weaker regions with fewer than 25,000 inhabitants are particularly affected: 20 percent already feel a shortage of doctors, 29 percent expect it.

As with care, there is a great deal of dissatisfaction with politics. Overall, doctors, at 72 percent (2010: 73 percent), still have a bad impression of the federal government's health policy; in the population it is 55 percent (2010: 61 percent). A clear majority of 70 percent of doctors believe that the legislature underestimates the shortage of doctors and their effects - despite the recently introduced care structure law. Most of the cornerstones provided by the law are, however, welcomed. For example, 95 percent of doctors support measures to improve the compatibility of family and work. Another 90 percent advocate financial incentives to share a rural supply contract with colleagues.
The President of the German Medical Association, Dr. Frank Ulrich Montgomery sees the government fundamentally on the right path with the SHI care structure law: “The law is intended to help patients continue to find a doctor near them. With all criticism of individual requirements, these are basically the right steps. ”In the medium and long term, however, further measures are necessary to make the health system future-proof. “We need to discuss how we can offer all patients the necessary treatment in the long term, given the limited finances, capacities and time resources. That is why we initiated the prioritization debate and continue it consistently. ”It is undisputed that medical progress will no longer be reproducible in the practices and clinics under the current financial framework conditions - least of all in a society of long life. "If the financial resources are not adjusted to the supply needs, then politics will have to face the prioritization debate sooner or later," says Montgomery.

Positive judgment on current health care Overall, satisfaction with the health system and current health care has increased again in recent years. 72 percent of the population and 88 percent of doctors judge “good” or “very good”. A majority of 59 percent of the population has had constant experiences with medical care in the past two or three years (2010: 56 percent). At the same time, worries about having to forego the necessary treatment in the event of illness are lower than in previous years - but still widespread at 32 percent. More than two thirds of the physicians see their freedom of therapy questioned for cost reasons (2010: 72 percent). Postponements are widespread for budgetary reasons: 59 percent of doctors have had to reschedule treatment for a later period, and 16 percent is often the case. In the last two or three years, 20 percent of patients have had to wait longer for an appointment - compared to 9 percent of privately insured patients. At the same time, 72 percent of doctors confirm from their own experience that they often receive patients in their practice for whom a medical visit is not necessary from a medical point of view.

The shortage of doctors is particularly noticeable in Thuringia. In Mecklenburg-Western Pomerania and Thuringia, there is the lowest level of satisfaction with the health system and health care in a nationwide comparison. The Thuringians are already most clearly aware of the lack of doctors (43 percent), least of all the Saarlanders (2 percent). At the same time, most patients in Thuringia also complain about longer waiting times in the past two or three years - both when making appointments (35 percent) and despite appointments in the waiting room (36 percent). In Berlin, very few had to wait longer for an appointment (12 percent). Concerns about not receiving the necessary treatment in the event of illness due to cost reasons are particularly pronounced in Thuringia (58 percent); in Rhineland-Palatinate (16 percent) the least are concerned. The complete country overviews can be found as a diagram at

Dark expectations for the future and low willingness to reform The development in the next ten years is still very pessimistic for the population. Just 16 percent are convinced that today's supply can be maintained for all strata of the population. The vast majority, on the other hand, expect additional burdens and restrictions: 79 percent expect rising contributions, 78 percent higher co-payments for medication. There will also be more and more "two-class medicine" (79 percent). In addition, many citizens expect demographic change to place an increasing burden on the health system: 61 percent expect full medical practices and problems to get an appointment. 51 percent even assume that expensive treatments will no longer be carried out on older people due to cost reasons. Against the background of an aging society, doctors have a similar opinion: a large majority still see the healthcare system as insufficiently prepared for the demographic challenges. 86 percent of doctors therefore believe that further fundamental reforms are necessary. Around three quarters of the population state that reforms are essential. Despite this insight, the majority of the population rejects drastic reform steps: 89 percent consider an increase in health insurance contributions to be unreasonable (2010: 87 percent), restrictions on the free choice of doctor reject 87 percent (2010: 85 percent). A large majority of the population (82 percent) is aware that you can contribute a lot or a lot to maintaining health. However, the survey results also show that health orientation has not increased in recent years: since 2005, only around a third have stated that they are very careful about their own health.

The MLP Health Report is a representative survey of around 1,800 German citizens and more than 500 doctors. For the first time this year, the core questions on the evaluation of health care by federal state were surveyed. (pm)

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