Increasing Intervention In German Health Care

Germany's growing use of elements of the planned economy to controlhealth care has set a "spiral of intervention" in motion, says Bavarian health economist Peter Oberender, who calls for a complete revamp of the incentive system for panel doctors.

He says the latest twist in the spiral was the introduction of practice budgets for all panel doctors from July 1, the third basic change in the budgetary system underlying the panel system in 18 months. The next reform takes effect January 1, 1998.

Mr Oberender says doctors themselves are criticizing the content of the new regulations and also the frequency with which they have to reorganize their practices. The unified system of evaluation (EBM), introduced in January 1996, aimed at ending the chaos in the medical fee system, was replaced by a modified system only a few months later. In fact, the EBM as a medical management approach led to increases of up to 30% in chargeable services for patients. The planned economy cannot resolve the basic problems of panel doctors while at the same time requiring them to spend more time working as accountants, he argues. The root failure of the system is that existing incentives fail in prompting either patients or doctors to economic and efficient use of health care.