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News of the Day ... In Perspective


Overhaul of German health system is Merkel’s first priority

Collapse of the proposed overhaul of the 123-year-old German health insurance system could raise doubts about Angela Merkel’s ability to head the coalition government. The controversial compromise plan has been put on hold for three months.

The project would create a central fund to collect and channel contributions to the country’s many health insurers. The plan is opposed by doctors, pharmacists, hospital managers, trade unions, and insurers. While it does not go far enough to solve the system’s financial problems, it is excessively bureaucratic and threatens jobs, say opponents (Bertrand Benoit, Financial Times 9/8/06).

The German system is described as being in crisis by an Oct 12 article in the New England Journal of Medicine. Although the official workweek is 40 to 42 hours, German physicians often put in 80-hour weeks. The compensation of the highest-paid German hospital doctors is less than 40% that of the lowest-paid U.S. hospital doctors. German doctors also complain that more than one-third of their working time is spent on documentation and other administrative tasks. Along with decreased pay for increased work, German physicians have also seen ever-growing limits on their professional autonomy.

Although Germany spends 10.8% of GDP on medical services, higher than the average 8.9% for the 30 countries in the Organization for Economic Co-operation and Development, there was a 20% loss in the number of hospital beds between 1991 and 2004. Half of all local hospitals are now said to be operating in the red.

Large numbers of German physicians work abroad, and it will take more than money to restore job satisfaction (Dennis Nowak, “Doctors on Strike—the Crisis in German Health Care Delivery,” New Engl J Med 2006;355:1520-1522).

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