Voters are not confident that politicians will enforce the necessary health system reforms

• 65 percent of citizens and 81 percent of doctors favour extensive reforms – only 14 percent believe in a long-term solution
• More than half of the population and doctors complain that healthcare standards have deteriorated
• Cost pressure: 41 percent worry that they will not be given the necessary treatments – doctors see their freedom to select therapies threatened
• Almost one in two prefers the “Bürgerversicherung” model

Wiesloch/Berlin, 5th August 2009 - Just a few weeks before the German Bundestag elections, citizens and doctors call for fundamental reforms to the health system, although they do not believe that this will be implemented successfully by politicians. Both groups also criticise the declining quality of healthcare standards and fear further cutbacks in the years to come. Doctors see their “therapeutic freedom” under threat as a result of the increasing cost pressure and are open to discussions about a “priority list”. These are some of the main results of the 4th MLP Health Report. The representative survey was commissioned by MLP, the independent financial services and wealth management consulting company, and conducted by the Institut für Demoskopie in Allensbach with support from the German Medical Association (Bundesärztekammer).

According to the survey, two out of three citizens and 81 percent of doctors consider extensive reforms necessary, but only 24 and 13 percent respectively expect to see any changes following the elections. In each group, 79 percent even doubt that politicians will be able to safeguard good universal healthcare standards on a fairly long-term basis. Only 14 percent (2005: 23 percent) of people surveyed believe that politicians will be able to deal with these challenges. The government’s health policy was also rated negatively: 62 percent of Germans and 87 percent of doctors do not “have a good impression”: “The results are an alarm signal for the parties to stop putting off the major health system challenges any longer,” comments MLP Chief Executive Officer Dr. Uwe Schroeder-Wildberg at the survey presentation in Berlin.

Although 64 percent of citizens rated the current effectiveness of the health system still as “good” or “very good”, almost 60 percent (doctors: 56 percent) have noticed a deterioration in care during recent years. When asked specifically, doctors put the general deterioration of patient care first, especially limitations in terms of treatments and prescriptions. Both groups expect to see further cutbacks in the next ten years: 80 percent of citizens expect insurance premiums to rise for statutory health insurance cover (GKV) and more than three quarters are reckoning with increased additional contributions for medication. 72 percent of citizens and 88 percent of doctors expect an increasingly two-tier medical system to emerge.

Increasing cost pressure is reflected in several of the results: For example, 41 percent of citizens are concerned that they will no longer be given the necessary treatment for cost reasons. 77 percent of doctors see their “therapeutic freedom” questioned, almost one in two cannot spend enough time with his/her patients. 86 percent “often” or “occasionally” provide healthcare services, for which the costs are not covered. Against this backdrop, doctors are supporting the “priority list” suggested by the German Medical Association. 63 percent of those who have heard the suggestion are in favour of the debate. The subject may well also be met with agreement in principle by the general population too – 57 percent of those surveyed are of the opinion that treatments and medication are “often prescribed unnecessarily”. “People have absolutely no confidence in government policies anymore. They have understood that the unlimited political promises to provide services and real cost-reducing policies just cannot be reconciled anymore. At the same time, they are completely disillusioned about how those politicians responsible for healthcare will reform the health system subsequent to the elections. People have totally lost their confidence in government healthcare policies. The citizens thus confirm the analyses by the medical profession. We initiated the debate for an honest prioritisation instead of hidden, and thus more risky, rationing at the German Medical Assembly in 2009. This debate will have to be addressed by politicians – whether they want to or not. Doctors will continue to make the structural problems clear and to campaign for sustainable solutions. Patients and doctors must, and will, continue to be the opinion leaders when it comes to health policy issues,” says Dr. Frank Ulrich Montgomery, Vice President of the German Medical Association.

Only 30 percent of those with statutory health cover consider the proposal made by the Marburger Bund for a “Health-Riester-Scheme” – private provisions with state-subsidies - as an “interesting” option. 58 percent (2008: 55 percent) would like to see an universal statutory insurance system – even if this means increased premiums. 42 percent call for a stronger consideration of health conscious behaviour when insurance services are reimbursed. The “Bürgerversicherung” model proposed by the SPD in their election manifesto is favoured by many: With 49 percent a relative majority of the population – and 54 percent of those with statutory insurance cover - are in favour of including everyone who is in employment in the statutory health insurance scheme (GKV). “The ‘Bürgerversicherung‘ is the wrong response to the challenges in the health system,” contradicts Uwe Schroeder-Wildberg. „The difficulties are the same - with or without the ‘Bürgerversicherung‘ – because the structural problems are not being resolved."

The first interim balance is mixed for the “health fund” (Gesundheitsfonds) launched at the beginning of the year: Since then, 29 percent of doctors in general and 41 percent of registered doctors with their own practices have noticed a deterioration in the quality of care. 16 percent of those who have already consulted a doctor this year have noticed changes. A minority of 17 percent reckons with back payments in the form of extra premiums with their insurance companies. The willingness to change health insurance within the statutory health cover system (GKV) has fallen dramatically following the introduction of the fund – this is an option only for 12 percent because of the standard premium rates.

According to 72 percent of practice-based doctors, privately insured patients are a “(very) important” factor for the economic success of their practices. 61 percent of the population – and 58 percent of those with statutory insurance – are convinced that the private health insurance provides better coverage. This result is substantiated by the question about their own insurance cover: While only 58 percent of those with statutory health insurance feel that they have good coverage, the figure is much higher among those with private insurance at 90 percent. Interest in supplementary private insurance cover has also continued to rise: In the meanwhile some 46 percent (1997: 23 percent) are considering taking out a (further) policy.

“Are you worried about not having sufficient cover should you require nursing care?” - 49 percent of respondents answered this question with a “yes”. When asked about the future developments of nursing care insurance, 34 percent think that everyone should make their own private provisions on top of a basic coverage scheme. 38 percent are however, of the opinion that healthcare cover should be the state’s exclusive responsibility.