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

1. 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

2. 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

3. 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

4. 114th German Medical AssemblyEthical issues • 2011 - public debate on: • Preimplantation genetic diagnosis (PGD) • Physician-assisted suicide

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. THANK YOU!