1 Agency for Quality in Medicine (AQuMed) Joint Institution of the GMA and NASHIP Doctors registration and re-licensing in Germany C. Thomeczek 2nd ENQual workshop Helsinki, 2./3. April 2004

The German Health Care System Basic Elements and Characteristics Solidarity Self-Government Contribution-Financed Comprehensive Coverage Branched Social Security System Benefit-In-Kind Principle

3 SHI + Private 7,6 Mill. Private: 7,2 Mill. SHI: 72 Mill. The German Health Care System Insured Persons Update: 1998 SHI = Statutory Health Insurance

4 The German Health Care System (Catalogue of) Benefits The Social Code Book V (SGB V) guaranties the insured what is sufficient (ausreichend) necessary (notwendig) useful (zweckmäßig) economic (wirtschaftlich) Articles 12, 28, 35, 70, 72, 92, 126,135, 139

5 German Statutory Health Insurance Participants and Money Flow 50 % sickness fund(s) contribution Assoc.of Statutory Health Insurance Physicians flat rate/ member/qtr employed physicians hospital budget based on DRGs lump sums and basic costs self-employed physicians employers employees

6 German Statutory Health Insurance Expenditure Update: 1998 domestic care€ 1.5 bill spa therapy € 2.4 bill pregnancy € 2.65 bill „sickness wages“€ 6.9 bill remediies and aids € 9.1 bill dentists € 10.6 bill drugs € 16.7 bill ambulatory physicians € bill hospital € bill other € 5.7 bill total € bill

German Statutory Health Insurance Participants and Relations (Ambulatory Medicine) Patient Doctor Sickness Fund (N) ASHIP Right of Treament Treatment Remuneration Right of Payment Membership BenefitRemuneration

8 41% 47% 6% 4% 2% public health statutory bodies other fields hospital private practice Active Physicians: 292,100 ambulatory care Update: Dec. 31,1999

9 Physicians in Germany Membership in Chambers and Associations of Statutory Health Insurance Physicians employed physicians (hospitals, Institutes, etc.) doctors in ambulatory care not working with sickness funds doctors in ambulatory care w/o medical activity leading state health officials in hospitals in ambulatory care licensed for hospital outpatient care licensed as external consultant Chamber of Physicians (National) Ass of SHI Physicians

10 Physicians' Self-government Chamber of Physicians (Public Body at Law) 1.Public tasks: professional code and supervision of the profession postgraduate education certification of particular training continuing medical training (voluntary CME-certificate) quality assurance ambulatory emergency service arbitration registration and membership fees 2. Professional representation and other tasks: representation in politics and media statements on draft bills and decrees expert's reports support of public health service publication of a press organ 3. Social tasks pension scheme welfare BÄK HGF-AD GHS /95

11 Physicians' Self-government (National) Association of Statutory Health Insurance Physicians (Public Body at Law) 1.Ambulatory health care provided under statutory health insurance: register of physicians (in ambulatory care) admission to the panel (together with sickness funds) admission of external hospital physicians supervision and auditing continuing medical education and quality assurance ambulatory emergency service planning of physician supply counselling of physicians seeking to enter the panel 2. Representation and contracts: representation in politics and media global contracts with sickness funds distribution of medical fees regulations for the distribution of medical fees 3. Social tasks relief organisation press organ

12 Medical Education in Germany min 6 y 3-6 y 1,5 y board examinations postgraduate training V. 1. basic medical trainig optional postgraduate training 2 y. (no title) subspeciality 2-3 y. (title) area 2 y. (title) student AiP fully licensed doctor sp examinations by state chambers of physicians AiP:partly licensed doctor Sp:specialist or general practioner V:pre-clinical board examinations 1.,2.,3.:board examinations (3 parts) graduate training practical training (graduate training) specialialisation subspecialisation, optional training speciality (title)

13 Health-Care-Modernisation-Law ( ) New Situation § 95 d SGB V “CME-Duty” …every statuatory health physician is obliged to prove … CME- activities regarding the state of the art medical knowledge every 5 years. …voluntary CME-Certificates of the chambers of physicians can be accepted…. …if the physician doesen´t fullfill his obligation, his payments will be cut…. § 137 (1) SGB V …(QA in hospitals) The Joint Federal Commission … defines criteria for CME all board certified physicians in hospitals have to fulfill every five years BÄK HGF-AD GHS /95

14 Health-Care-Modernisation-Law ( ) New Situation before CME part of professional law goverend by the Chambers of Physicians (voluntary CME-Certificate) for certain procedures certificates required for SHI-physicians (certification by [N]ASHIP) after CME for SHI-Physicians and board certified hospital physicians defined by Joint Federal Commission Joint Federal Commission consists of –(N)ASHIPs, –the German Hospital Federation, –Assosiation of Sickness Funds Procedures of the JFC have to be approved by the Federal Ministry of Health BÄK HGF-AD GHS /95

15 Thank you ! In life there are no solutions There are only forces which are in motion You have to generate them And the solutions will follow. Saint Exupe'ry