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German government breaks off talks with doctors

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:874
  1. Annette Tuffs
  1. Heidelberg

    The German health minister, Andrea Fischer, of Germany's Green party, has had enough. Last week she declared that she will not discuss any further her proposed health reform with representatives from the Kassenärztliche Bundesvereinigung.

    Members of the organisation (which represents 110 000 non-hospital doctors), who treat patients insured with Germany's various insurance companies, were once more questioning the compromise that the ministry and their organisation had reached on the drugs budget (28 August, p 536).

    Under the reform, the government has set a strict budget for drugs, and if doctors prescribe more than the budget allows, their annual income will be cut.

    Again, the organisation has announced that patients will have to wait for drugs or pay for them out of their own pocket, if the annual budget becomes overdrawn.

    Ms Fischer came under additional pressure last week when more than 25 000 doctors, nurses, dentists, chemists, and other health workers from all over Germany marched through central Berlin last week, using the slogan “Health reform-laughter alone does not cure you.”

    However, despite Fischer's apparent stamina it is unlikely that the health reform will survive passage through parliament. At the very least, it will undergo major changes.

    After a recent expert hearing questioned the feasibility and ethics of a healthcare budget, the ministry is planning further discussions with more moderate doctors, such as the president of the Bundesärztekammer (German Medical Association), Jörg Hoppe.

    Dr Hoppe is against the overall healthcare budget but is willing to find acceptable compromises as long as all partners in the health system take responsibility.

    The administrative costs of the health insurers should be reduced, he said, pointing out that the insurers spent about DM13bn (£4.2bn; $6.7bn) each year on administration alone, a figure which has risen this year by 4.6%.

    Even if a new compromise is reached, the healthcare reform bill could still fail because the federal council of German states might reject it. Indeed, it has already indicated its intention to do so, should it be submitted in its present form.

    After losing the last four state elections the Social Democrat/Green coalition has lost its majority in the council and would need support from opposition parties in the federal council. Furthermore, more state elections are to come, and the federal government is becoming increasingly anxious about its election chances. The chancellor, Gerhard Schröder, has therefore had official talks with doctors and will do so again in October.

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