Der Allgemeine Patientenverband wurde auch von internationalen Zeitschriften zu Entwicklungen im deutschen Gesundheitswesen befragt. So im Jahr 2004 vom Canadian Medical Association Journal (CMAJ) zur damals neu eingeführten Praxisgebühr.
Claudia Orellana
Five months after its introduction, the controversial new €10 fee charged to patients for the first visit to a doctor each quarter, has started to show effects. Figures released by the Association of Statutory Insurance Physicians (KBV) in late April showed an average fall of 10% in the number of doctor visits during the first quarter of 2004. General practitioners registered a fall of around 9% and consultants, 10.5 %. The fee is part of the health reform introduced in January 2004 as an attempt to cut ever increasing costs. After running a €2 billion annual deficit for the previous 3 years, the statutory health insurance system has moved into the black, making it possible to reduce monthly insurance payments. “The fee is accomplishing its regulatory effect”, declared Health Minister Ulla Schmidt on June 9th.
“The crucial question is not just how many people are staying away from the doctor’s but who is staying away”, emphasises Roland Stahl, KBV’s spokesperson, Cologne. A survey by the Employees Health Insurer (DAK) released on June 3rd, shows that 9% of people insured with them admitted going to work despite feeling slightly ill. Of those interviewed who had reported sick for less than 3 days in 2003, 20% admitted having visited the doctor mainly to get permission not to go to work. “These results clearly suggest that unnecessary doctor visits are being avoided, which argues in favour of the fee”, comments DAK spokesperson Rolf Mentzell, Hamburg.
Stahl argues that the fee will work well if it deters those with a psychological compulsion to make multiple doctor visits: “Doctors will have more time for the genuine patients which is what we and the lawmakers want. But if the fee keeps socially disadvantaged patients away, naturally it would be disastrous.”
Christian Zimmermann, (president of the General Association of Patients, Marburg) fears that this is exactly what is happening. “The fee operates by social selection”, he claims. “For those who earn enough, €10 is nothing and they can afford to go to the doctor whenever they feel they need to, while those who live in difficult financial circumstances have to think twice”.