Doctors and patients meet around a billion times a year in Germany. Many of these treatments are unnecessary and cause high costs, say health insurance companies, doctors’ associations and politicians. Suggestions for improvement vary.
Almost 54 million people visited their family doctor at least once in 2022. Together with the numerous specialists from gynecologists to psychotherapists, we have around one billion doctor contacts every year. The actual number of doctor visits is slightly lower because it also counts as contact if, for example, your blood is sent to a laboratory for analysis – after all, a laboratory doctor works there, even if you never see him.
Politicians, doctors and health insurance companies have been criticizing for decades that many of these visits are unnecessary. The practice fee charged from 2004 to 2012 was an attempt to limit the number of doctor’s visits. As is well known, this worked very poorly, which is why the measure was abolished. With the rising costs of the health system in recent years, however, the discussion is now again about where money can be saved – and fewer doctor’s visits are high on the list. This is a good opportunity to analyze the topic in more detail.
We have already mentioned the total number of doctor contacts. In total, there were 15.27 days with one contact with a doctor per resident. With 17.18 days, women are well ahead of men with 13.31 days, but this is also because all visits to gynecologists are included in the context of pregnancies. In fact, gynecologists are the most consulted specialists after general practitioners and laboratory doctors.
15.27 days with contact with a doctor is initially a value without any meaning. In order to classify this, we have to compare it in time and space. The former shows that the number of contact days has remained roughly the same over the past twelve years. The lowest value was an average of 14.17 contact days in 2018, the highest was 15.41 in 2016.
In international comparison, we are above average. OECD statistics for 2021 indicate an average of 9.6 doctor visits per year for Germany. South Korea leads with 15.7 contacts, well ahead of Japan with 11.1. Germany follows in fourth place behind Slovakia. The OECD average is only 6.0 doctor visits.
But: These statistics also show that people in richer countries such as Korea, Japan and Germany have a higher availability of doctors and lower personal costs for a visit to the doctor. It is not for nothing that emerging countries such as Costa Rica (2.1), Brazil (1.6) and Mexico (1.5) are at the bottom of the scale.
In addition, our society is on average older than in other countries and older people naturally go to the doctor more often.
Germany has one of the most expensive healthcare systems in the world. According to the OECD, per capita spending was $8,011 in 2022. Private costs are also included here, but they make up 15 percent of the total costs. Adjusted for purchasing power, only the USA spends more per capita at $12,555 and Switzerland at $8,049.
The German healthcare system also consumes around 20 percent of all government spending, an increase of around two percent between 2011 and 2021. This is also a high figure internationally, only Japan (22 percent), the USA, Great Britain and Ireland (21 percent each) are behind here in front of us. The OECD average is 15 percent.
There are many reasons for the high costs of the German healthcare system, and many of them are positive. For example, we have a higher density of doctors, nurses and hospital beds than the average of OECD countries. The private additional payments are lower than in other countries. The residents are correspondingly satisfied with the system. In an OECD survey, 85 percent praised the availability of doctors and care – the OECD average is 67 percent – and just 0.1 percent of patients said the health system was not meeting their needs. This is the lowest value in the community.
However, a large supply of staff and hospitals also costs more money. There is also the global paradox that a country’s healthcare costs increase the more the quality of care improves. This is because high-quality treatments and operations with better equipment are becoming increasingly expensive.
In public discussion it is often argued that people in Germany often go to the doctor unnecessarily. Last week, the chairman of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, complained to the Bild newspaper that it was “not uncommon for a patient to go to several general practitioners and specialists who carry out similar examinations. This costs the practices time and the health insurance companies money.” Jonas Schreyögg, a member of the expert council for assessing developments in the healthcare system, said in an interview in February: “The entire population has too many contacts with doctors, including those with chronic illnesses. There is uncoordinated utilization.”
The difficult thing is defining when a visit to the doctor is “unnecessary”. Schreyögg primarily means when patients go directly to a specialist instead of going to their family doctor – and often choose the wrong person who is not responsible for their problems. He also estimates that specialists call in patients with chronic illnesses too often because they are paid quarterly for this. For the KBV, a visit to the doctor is unnecessary if it means repeating an examination, i.e. a patient gets a second or third opinion.
The OECD is trying to approach the issue by looking at how often people with three specific chronic diseases that could be treated on an outpatient basis according to medical standards are referred to hospitals. This is intended to be an indicator of how much unnecessary treatment a country carries out. Germany has 193 admissions per 100,000 inhabitants. This is a value in the top group, which is led by Denmark with 277. The OECD average is 129. However, the values are falling massively both in Germany and in other countries.
Here we come to the real crux of the discussion. Without a correct definition of an “unnecessary doctor’s visit” and a concrete recording of these doctor’s visits, it is difficult to calculate the costs of such contacts. In fact, neither the KBS nor Schreyögg provide any figures here. In other words: Even if not a single unnecessary examination were carried out from tomorrow, no one could say with certainty how much money this would save the German healthcare system.
Despite all the definitional problems, it is undisputed that money could be saved and the often limited capacity in doctor’s offices and hospitals could be reduced if we went to the doctor less. However, the way to achieve this is controversial. In principle, there are three possible solutions:
a) The reintroduction of the practice fee: A study by Professors Stefan Fetzer from Aalen University and Christian Hagist from the “Otto Beisheim School of Management” in Düsseldorf proposed a “contact fee” in March. 15 euros would then be due for every visit to the doctor, although the amount should be capped for people with low incomes. In its new basic program, the CDU is open to such a fee without going into detail. More personal contribution to treatment costs is also an option here.
b) A bonus for few visits: While a contact fee would be more of a punishment for people who go to the doctor, the KBV would rather reward people who don’t do this excessively. The association is proposing to introduce an optional tariff under which people would receive up to 100 euros per year if they nominate a doctor who will always be used as a first point of contact. This can be the family doctor, but for women it can also be a gynecologist or, for those with chronic illnesses, a specific specialist. This would then refer patients to the right specialist if necessary.
c) More prevention: A good way to prevent visits to the doctor would also be to ensure that people don’t get sick or hurt themselves so often. The Greens, for example, are committed to this and want to invest more money from the federal budget in precautionary measures. In fact, this year more funding is going into counseling centers for people at risk of suicide and programs to prevent sexually transmitted diseases. But the Green Party’s demands for less sugar in children’s products also come into play here.
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