News of the Day ... In Perspective08/21/2006
German and Swiss doctors protest
A series of strikes and demonstrations by German doctors demanding less work and more pay took Germany by surprise this year.
While confessing that “Germany does not have a true free market in the medical field,” Professor Nagel of the University of Bayreuth did not acknowledge this to be the cause of the widespread discontent.
The “ongoing process of cost reduction” and “battle for a solidarity system” involve a number of strong-arm measures, reports Alphonse Crespo, M.D., of the Institute Constant de Rebecque. These include: “conscription of all income groups into regulated health schemes, plundering of private insurance companies and punishing pharmaceutical R&D by elbowing doctors into prescription of low-cost drugs.”
Crespo notes that “[c]oercing the well to do into public health insurance can only increase the number of rationed travelers in an overloaded boat. The losers will be those most in need of subsidized care.”
The Bonus Malus laws, which punish doctors for prescribing expensive drugs, are one cause of the physician protest movement. A survey showed that 60% of the public think they will no longer be able to get the best possible treatment from their doctor.
In Switzerland, 100,000 medical practitioners marched on Bern last April to protest “the dismantlement of basic family doctor medicine and house-medical services.” This event, Crespo predicts, “may mark the end of pseudo-consensus and one-way compromises between medical professionals and the administrative authority.”
Swiss doctors are rankled by increased bureaucratic intrusions into the patient-physician relationship and barriers to diagnostic tools and free choice of treatment. In 1994, new laws “established compulsory insurance and spawned a de facto cartel of insurance providers anointed with almost unlimited regulatory powers.”
In 2000, federal authorities suspended the opening of new medical practices for 5 years, on the theory that cost is directly related to the number of practicing physicians. Although the number of visits to doctors has been shown to be unrelated to the density of GPs, the ban has been extended to 2008.
“Top to bottom planning is now the rule in cantonal and federal health policymaking and the opinion of doctors has become irrelevant,” Crespo states.
See: “Getting Rid of Marx and Bismarck in Health Care: the German Quagmire” and “The Other Side of Compromise: the Gloom of Swiss Doctors” by Alphonse Crespo, The Doctor’s Notebook.