Doctors in Germany will soon be able to treat patients via phone, text message, email or online chat after a large majority voted in favour of the change at the AGM of the German Medical Association (Deutscher Ärztetag), following a controversial debate.

Current restrictions on remote treatment mean doctors are currently not allowed to provide advice or medical treatment soley via print and online – there needs to have at least been an initial in-person consultation.

Telehealth must be deemed by the physician to be “medically acceptable” on a case-by-case basis, and the usual standards of care apply regarding diagnosis, consultation, treatment and the maintaining of records.

The move was welcomed by Federal Health Minister Jens Spahn as a way for patients to avoid long waiting times, but the German GP Association has said it fears it might be seen as a “cost saving program for health insurers”, with one board member reportedly saying that foreign call centre operators would be rubbing their hands together in anticipation of a new market opening up.

Current restrictions do not apply to privately-paying patients talking to doctors abroad, which has created a small market.

The decision must now be implemented by regional physician groups, a process which is expected to take two years.

A consultant based in Munich tells us: “At the end of the day for private health insurers there is some cost savings potential. I don’t see how it will lead to real cost savings for the statutory health insurers because what they get is all negotiated, as part of the outpatient budget. They have to say “now we’re becoming more efficient and I have to give you back money’.

“At the moment, first-time prescriptions need to follow a personal visit but rollover prescriptions don’t – they can be done over the phone for example. That will have to change to some extent, but how it will work is vague.

“As for foreign call centres – and you see this in teleradiology as well at the moment – currenty you can’t export medical services from German ground right now, or you have to use a German-licenced physician who sits within the EU. And it’s difficult to offshore anyway because of the language requirements.

“There will be some interesting concepts coming out of this, using digital tools, but we’re talking 5-10 years down the line.”

A second Germany-based consultant added: “I expect to see restrictions. There was a discussion at the German Medical Association – which passed the vote by a large majority – about how they were looking to keep commercial parties out of this development. They don’t want investors setting up call centres on the back of this. They want it to be “normal” doctors practices using telemedicine as an addon to their usual work.

“But even if there are guidelines or rules to keep investors from commercialising telemedicine, I wouldn’t expect them to last forever. In any event, I expect there will now be three to four months of discussion about implementation after which things will be clearer.