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German doctors in protest march

26th September 2008

More than 20,000 doctors in Germany have staged protests in the centre of Berlin about the way the country's health service is run.

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Closing their practices, the doctors took to the streets to demand better pay and less bureaucracy, vowing to continue until the government took action.

The protest folows a series of strikes by young hospital doctors with similar demands, which closed hospital services down to barest emergencies.

The GPs and specialists who run their own practices are calling for greater government funding for healthcare.

According to Joerg-Dietrich Hoppe, president of the German Medical Association (Bundesärztekammer), the German health system needs an increase in budget of about €7bn [£4.8bn; $8.6bn] for outpatient and GP care alone.

Doctors were also calling for less paperwork, which is cutting into time that could better be spent in caring for patients, and was affecting the amount of time and attention they could devote to the doctor-patient relationship.

Hoppe said around one third of doctors’ practices in Germany were struggling to survive economically, and some rural areas would lose GP care entirely if the government did nothing.

All outpatient care is financed by German health insurance companies, which provide fixed budgets shared out according to a distribution formula. This means that where more care is delivered, each doctor gets a smaller slice of the budget, rather than the budget following patients.

Restricted funding policies mean that doctors have to watch what they spend on their patients or face financial penalties, against a background of growing demand for medical care in an ageing population.

Effectively, this means that German doctors' incomes have not grown in the past 10 years, leading to brain drain.

According to the German Medical Association, the number of qualified doctors emigrating to other European countries or the United States is on the rise.

The UK has more than 4,000 doctors from Germany registered. Those who stay behind have to moonlight by taking locum jobs to make ends meet.

Only about 60% of German medical graduates stay in clinical medicine now.

Experts like Matthias Schrappe, medical director of the private Witten/Herdecke medical school, say that the funding shortage is a result of the way the country’s healthcare system is structured, rather than an overall lack of money.

One problem relates to a duplication of services between hospital outpatient specialist clinics and specialist practices in the community.

But the government denies that funding structure is the problem. Federal health minister, Ulla Schmidt, said the government would publish draft proposals to reform the country's health insurance system by the end of March.

This would include a fairer system of payment for doctors, Schmidt said.


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