BMJ  2005;331:234-235 (23 July), doi:10.1136/bmj.331.7510.234-b

Letter

A tale of two Germanys

East Germany's health system provides lessons 14 years on

EDITOR—Public health outcomes in East Germany have substantially improved since unification with West Germany.^{1 2} This process should be two way,³ and neglected aspects of the east's former healthcare system have indeed resurfaced in Germany's healthcare reform.

State owned health centres (policlinics) were one component of primary health care in former East Germany, housing general and specialist doctors and dentists. This integrated model was efficient and cost saving: facilities and laboratories were shared, alternative treatment and prevention strategies were coordinated, and referrals to specialists were well monitored, as well as each patient's case. Policlinics did not conform to the west German concept of independently contracted doctors paid on the basis of an item of service, so they did not survive in east Germany after 1995, as predicted in 1992.⁴

In 2000 integrated healthcare centres were instigated in Germany's healthcare reform to increase cooperation between general doctors, specialists, and hospitals; to improve communication between institutions; and to reduce healthcare costs.⁵ Implementation has been slow because of traditional conflicts of interest and the lack of direct financial incentives, but recent legislation introduces the possibility of integrated healthcare centres being run by independent management companies.

These centres are similar to the policlinics of former East Germany. Had they survived they would have been a working example of how integrated healthcare centres can operate.

dirk.meusel{at}mailbox.tu-dresden.de
Medical Faculty, Dresden University of Technology, D-01277 Dresden, Germany

Medical Faculty, Dresden University of Technology, D-01277 Dresden, Germany

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Competing interests: None declared.

References

1. Nolte E, Shkolnikov V, McKee M. Changing mortality patterns in east and west Germany and Poland. II: Short-term trends during transition and in the 1990s. J Epidemiol Community Health 2000;54: 899-906.[Abstract/Free Full Text]
2. Pittrow D, Krappweis J, Rentsch A, Hach I, Schindler C, Bramlage P, Kirch W. Patterns of prescriptions issued by nursing home based versus office-based physicians for frail elderly patients in German nursing homes. Pharmacoepidemiol Drug Safety 2003;12: 595-9.[Medline]
3. Nolte E. Integration of east Germany into the EU: Investment and health outcomes. In: McKee M, MacLehose L, Nolte E, eds. Health policy and European Union enlargement. Maidenhead: Open University Press, 2004: 73-81.
4. Freudenstein U, Borgwardt G. Primary medical care in former East Germany: the frosty winds of change. BMJ 1992;304: 827-9.
5. Bundesministerium für Gesundheit und Soziales. Sozialgesetzbuch: Fünftes Buch. www.bmgs.bund.de/download/gesetze_web/gesetze.htm#sgb05/sgb05xinhalt.htm (accessed 26 Jan 2005).

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