Why there is no quick fix for German healthcare
At times, it can feel like healthcare reform moves at the pace of an oil tanker, and currently, nowhere is this more true than in Germany. Among the issues holding the EU5 market back are an allergy to digitalisation, an inability to make unpopular decisions, and the rigidity of roles in the medical profession.
Role rigidity among German nurses is rife. There are some activities that only registered nurses can do – without, one could argue, good reason. Healthcare is an environment where workers need to move fast, and artificially creating bottlenecks is not helping the workforce crisis.
France may hold the answer. It has created a new role, that of the “medical assistant”, who does the admin workload of physicians and takes on some of the roles fulfilled by nurses as well. Not that France is perfect. Dentistry nurses aren’t allowed to even switch on x-ray machines.
German patients are also sceptical about data privacy. Although there is some acceptance from complex patients (think oncology and cardiology) that their data could further research and help others, there is still a lack of data in the system. Germany has switched its personal health record system to an opt-out system to encourage people to use it, but that’s not a solution for sensitive data. Politicians need to make better arguments for why Germans should give their medical data as standard practice.
Speaking of which, the political system can be a bottleneck in and of itself. Germany is usually run by a coalition government, which is fantastic for making sure everyone has their voice heard. But this then makes it nigh on impossible for unpopular decisions to be made.
Health minister Karl Lauterbach’s top-to-bottom healthcare reforms were initially refreshing. Lauterbach saw hospital overactivity, and felt some hospitals needed to be closed. Over Christmas, he bemoaned “locust investors”, otherwise known as PE firms, owning outpatient clinics.
But soon after this grandstanding, it seemed the necessary compromises in German politics would kill or water down Lauterbach’s ideas – for good or ill. Lauterbach will likely also find if he wants to rely more on outpatient care – and he says he does – he should probably leave PE firms well enough alone. And politically, because of the devolved way Germany operates, Lauterbach cannot close hospitals without the green light from the regions. These regions are run by people who are elected locally, and the chances of winning elections are somewhat diminished by making unpopular choices – like closing local hospitals. Everyone’s voice is heard, and there appears to be general agreement some hospitals need to be closed – local politicians are just hoping they can be closed somewhere else..
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