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18th Symposium of Central and East European Chambers of Physicians (ZEVA) Country Report: Germany. 30 September – 1 October 2011 in Cracow. Dr. Klaus-Dieter Wurche. 114th German Medical Assembly Elections Ethical issues Healthcare policy

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18th symposium of central and east european chambers of physicians zeva country report germany

18th Symposium of Central and East European Chambers of Physicians (ZEVA)Country Report: Germany

30 September – 1 October 2011 in Cracow

Dr. Klaus-Dieter Wurche

table of contents
114th German Medical Assembly

Elections

Ethical issues

Healthcare policy

Legislation to improve the structure of SHI healthcare provisions in ambulatory care

Reform of physicians‘ remuneration

Patients‘ rights

Table of Contents
114th german medical assembly elections
Newly elected president and vice-presidents of the

German Medical Association:

President - Dr. Frank Ulrich Montgomery (Hamburg)

Vice-President - Dr. Martina Wenker (Lower-Saxony)

Vice-President - Dr. Max Kaplan (Bavaria)

Secretary general of German Medical Assembly and German Medical Association retired.

114th German Medical AssemblyElections
114th german medical assembly ethical issues
114th German Medical AssemblyEthical issues
  • 2011 - public debate on:
    • Preimplantation genetic diagnosis (PGD)
    • Physician-assisted suicide
114th german medical assembly ethical issues1
Preimplantation genetic diagnosis (PGD)

July 2010: Federal Court ruling highlighted lack of explicit regulation within the Embryo Protection Act regarding PGD

Calls for legislators to clarify legal status of PGD in Germany = lengthy debate in politics and society

Position of the medical profession formulated at 114th GMA:

“Ethical considerations favour permitting PGD within limited

boundaries and subject to certain conditions”

July 2011: New law passed permitting PGD under certain circumstances. Each case must be individually assessed by an ethics committee

114th German Medical AssemblyEthical issues
114th german medical assembly ethical issues2
Physician-assisted suicide

June 2010: Ruling by the Federal Court stating that physicians, carers or relatives who carry out the express wishes of a patient to withhold life-extending treatment cannot be prosecuted.

February 2011: German Medical Association published revised guiding principles on physician-assisted suicide:

”It is not the task of a physician to assist a person in taking his/her own life.”

Delegates of the 114th German Medical Assembly demanded stronger wording to emphasise that physician-assisted suicide is also contrary to the ethos of the medical profession

 Professional Code under revision to incorporate demand für stronger wording

114th German Medical AssemblyEthical issues
slide7
Healthcare policyLegislation to improve the structure of SHI healthcare provisions in ambulatory care
  • Draft law resolved on 3 August 2011 – planned implementation 01/01/2012
  • Prompted primarily by the unequal distribution of healthcare provisions in urban (many physicians) and rural (few physicians) areas
  • Aims:
    • To ensure the comprehensive provision of local medical services according to the population’s needs
    • To ensure rapid access to innovation
slide8
GMA position on proposed legislation:

Action imperative however should be based on incentives rather than punitive measures

Cross-sector dimension essential to requirements planning rather than exclusively sector-specific

 Consequence: Chambers of Physicians must be included into requirements planning

Healthcare policyLegislation to improve the structure of SHI healthcare provisions in ambulatory care
healthcare policy reform of physicians remuneration
Physician fee schedule (Gebührenordnung für Ärzte – GOÄ): Catalogue of benefits enacted by the Federal Government listing minimum and maximum fees to be charged for privately reimbursed medical services

Balances the interests of patients and physicians:

protects patients from excessive premium payments

ensures that physicians and hospitals can cover their expenses

Healthcare policyReform of physicians‘ remuneration
healthcare policy reform of physicians remuneration1
German Medical Association demands revision:

Last complete revision 1983 = GOÄ hasn’t kept pace with price rises, medical progress not taken into consideration

Healthcare increasingly market-orientated = revised GOÄ essential to avoid price dumping at the expense of quality

The GMA has produced a comprehensive and detailed suggestion for a new GOÄ and its continuous development based on an expert analysis.

Demand: No exemption clause, no selective agreements between individual physicians and private health insurance companies.

Healthcare policyReform of physicians‘ remuneration
healthcare policy patients rights
2004: Office of Patient Commissioner created

Federal Government plans to introduce new patients’ rights legislation to strengthen the position of patients with respect to service providers and health insurance funds

Existing laws to be consolidated into one legislative text

Especially with relation to patient safety and processes for obtaining compensation in the event of medical malpractice

Healthcare policyPatients‘ rights
healthcare policy patients rights1
GMA position on proposed legislation:

Patients’ rights in Germany are already sufficiently protected under law, the problem is rather a lack of access to objective information on them

The professional code of the medical profession binds physicians to observe patients’ rights in a spirit of partnership

Further legal regulation would be likely to create additional bureaucracy to the detriment of physicians

Healthcare policyPatients‘ rights