Choosing a doctor: Should doctors enter into a price war?

According to a new proposal, patients should in future be able to choose their doctor based on different prices. The CDU health expert Hermann Gröhe writes in a new paper from the Konrad Adenauer Foundation that “more serious thought than in the past” must be given to using “price signals” to strengthen the cost awareness of all those involved.

In the paper, social expert Jochen Pimpertz from the employer-related Institute of the German Economy (IW) argues that those with statutory health insurance will be able to choose between tariffs with different care models in the future. There are currently uniform fee rules for doctors and health insurance companies generally have the same contributions for all members. The “Tagesspiegel” first reported on Pimpertz’s proposal.

“Continuing like this won’t work.”

“It is becoming increasingly clear that demographic change is heading into a difficult phase,” Pimpertz told the German Press Agency in Berlin. “Believing that we can carry on as before or look for additional sources of financing on our own to keep the current health system afloat longer will not work.”

According to official forecasts, health insurance contributions for millions of health insurance members will likely increase significantly in the coming year. Federal Health Minister Karl Lauterbach justified the enormous increase, among other things, with inflation and higher wages. In addition, the health system is very inefficient, said the SPD politician and promoted his hospital reform. IW researcher Pimpertz said with a view to the federal election, which is expected to take place in just under a year: “The task of the next Federal Minister of Health is to provide answers here.”

However, Gröhe, who was Minister of Health under then Chancellor Angela Merkel (CDU), makes it clear that the “solidarity character of our healthcare system” should not be questioned. Pimpertz also emphasizes that the principle of solidarity and the high level of medical care in Germany should remain.

What specifically is proposed

Specifically, the IW researcher suggests that basic care be financed through solidarity as before – but that there are options available that have different costs for the insured. For their part, practices and health insurance companies should be given more freedom to enter into contracts with each other. This means that they should also compete with each other through different prices.

A proposal by Josef Hecken in the paper fits in with this. Hecken – a leading player in the German healthcare system for decades and chairman of the Federal Joint Committee – is calling for a massive expansion of family doctor contracts, i.e. family doctor-centered care, as is particularly widespread in Baden-Württemberg. Today you can take part in such a model voluntarily and then, in principle, agree to go to your family doctor first. In the future, Hecken writes, this could be changed so that insured people who do not want to take part in the family doctor model can “maintain the current status quo through premium surcharges.”

Fewer double examinations

Pimpertz criticizes the fact that the existing family doctor models lack financial advantages: Participation and thus the giving up of the freedom to choose a doctor are no cheaper for insured persons. “That kills any incentive.” According to Hecken, family doctor-centered care often fails due to regulations regarding approval.

“As a result, in today’s care, unnecessary patient-doctor contacts take place, double and triple examinations are carried out and the phenomenon of ‘doctor hopping’ can be observed in some patients,” complains Hecken. “This leads to a waste of valuable human and financial resources and is also a reason for long waiting times, especially for specialist appointments.” In Baden-Württemberg it is impressively demonstrated that a binding choice of doctor’s practice can shorten waiting times, improve the quality of care and reduce expenses.