5th MLP Health Report: German health system lags behind in international comparisons

• The Dutch, Swiss and the Swedes evaluated their health care better and worry less about treatment when ill
• Criticism of the German health reform: 75 percent of citizens and 93 percent of doctors doubt that the system can be financed in the long-term
• Over 70 percent of citizens and doctors believe that the burden is unjustly distributed – in particular, the majority thinks that the pharmaceuticals industry is treated favourably
• Nursing care: 64 percent of the population demand more action from politicians

Wiesloch/Berlin, 25th November 2010 – Despite an improved assessment, the German health system is still given a poorer rating than the example countries Switzerland, The Netherlands and Sweden. On top of this, many Germans are unsatisfied with the current health reform and criticize the unfair burden distribution in particular. Citizens and doctors alike are still very worried that the increasing cost pressure will impair the quality of the health care. At the same time both groups admit that the Germans often consult a doctor unnecessarily. These are some of the main results of the 5th MLP Health Report. The representative survey was commissioned by MLP, the financial services and wealth management consulting company, and conducted by the Allensbach Institute for Public Opinion Research with support from the German Medical Association (Bundesärztekammer).

Overall 70 percent of citizens (2009: 64 percent) and 88 percent of doctors (2009: 82 percent) say that: The current services provided under the German health system are “good” or “very good”. These values are higher in The Netherlands with 77 percent, in Sweden with 81 percent and 93 percent in Switzerland. At the same time 51 percent (2009: 59 percent) of Germans say that the quality of the health care provisions in the last two to three years has deteriorated more compared with citizens in the comparative countries (The Netherlands: 34, Sweden: 20, Switzerland: 15 percent). The concern about having to forego necessary treatment in cases of illness is also more pronounced: While 42 percent of German citizens voice this concern, the comparative figures in the other countries are lower with 30 percent in Sweden, 21 percent in The Netherlands and just 18 percent in Switzerland. The comparative countries were selected for several reasons, but mainly because doctors have repeatedly cited them as “leading countries” in the MLP Health Report.

Respondents doubt the success of the health reform
The respondents expressed clear criticism of the latest health reform, which becomes effective as from January 1st 2011. While 75 percent of the population doubt that the measures passed will safeguard the funding of the health system for a longer period of time, this figure totals 93 percent among medical practitioners. 82 percent of citizens consider the extended option under the reform for compulsory health cover to demand additional income-independent premiums to be unfair. 22 percent of those with compulsory health insurance already pay additional premiums today, and a further 38 percent expect to do so in the foreseeable future. Of these, 25 percent are considering changing their compulsory health insurance.

71 percent of those with compulsory health insurance view the proposed extension of the cost transparency by Federal Minister Philipp Rösler as a positive move. Overall the population and doctors have a critical stance towards the new government health policies – 61 and 73 percent respectively have an “unfavourable impression”. However, these values have improved slightly in comparison with the Grand Coalition (62 and 87 percent respectively). When asked whether political decisions will ensure good health care in the long term, 80 percent of doctors (2009: 79 percent) and 77 percent of citizens (2009: 79 percent) are sceptical. In comparison: In Switzerland, The Netherlands and Sweden the respondents are less sceptical with 65, 63 and 56 percent respectively.

“We need a long term change in the health policies. There is no patent recipe to solve all of the system’s problems in the short term and be fair to all interested parties. However, as the example of Switzerland very clearly shows, a high level of satisfaction with health care can be achieved of the insurants are given more personal responsibility,” comments MLP Chief Executive Officer Dr. Uwe Schroeder-Wildberg at the survey presentation in Berlin.

Major concern about further service reductions
One reason for the current dissatisfaction with political decisions is how the burden is spread under the health reform – more than 70 percent of citizens and doctors consider this unjust. Both groups believe that the burden upon insurants is too high (citizens: 66 percent, doctors: 54 percent); while pharmaceutical companies are treated too favourably in the opinion of 61 percent of respondents and 54 percent of doctors. Concern about service reductions is just as high as it was last year: 42 percent of Germans are concerned that they will not be prescribed the required treatment if they fall ill. At the same time, 38 percent of those insured under the compulsory state health system, but only 9 percent of those with private health insurance, have the feeling that treatments or medication have not been prescribed for cost reasons. In addition, 55 percent of doctors state that they have, in the past, not prescribed a medically sensible treatment for cost reasons and 72 percent of them see their therapeutic freedom under threat.

When asked about the cause of the compulsory health insurance’ financial problems, 70 percent cite overpriced medication prices and 68 percent the demographic trends. More than every second patient believes that many Germans often consult a doctor unnecessarily. This assessment is confirmed by 70 percent of doctors.

Doctors support moves for insurants to make a higher contribution to the costs
Several possible solutions to ensure an efficient health care system have crystallized from the survey. Approximately two thirds of citizens support the proposal that insurants who do not go for medical checkups should make a higher contribution towards treatment costs. The suggestion that benefits or services are no longer paid for that are not absolutely necessary to heal the illnesses was met with similar approval. 73 percent of doctors demand that the insurants pay part of the costs – with an upper limit - themselves. 69 percent would also welcome the introduction of a positive list for medications.

Private health insurance is viewed positively
Are you well-covered by your health insurance? 87 percent of the privately insured answered this question in the affirmative – 28 percent points more than those with compulsory health insurance cover. At the same time, almost three quarters of doctors surveyed said that they give more attention to privately insured patients. According to 75 percent of practice-based doctors, privately insured patients are an “important” or “(very) important” factor for the economic success of their practices. Interest in supplementary private insurance cover is still high: At present, 43 percent of those with compulsory health insurance are considering taking out a (further) policy. “This result shows that many insurants would like comprehensive and individual insurance cover“, comments Uwe Schroeder-Wildberg.

Citizens demand reform of nursing care insurance
Only 15 percent of Germans believe they have sufficient nursing care cover under the compulsory state system; more than two thirds feel this cover is not sufficient. At the same time the population demands that politicians should reform the nursing care insurance system: 64 percent are of the opinion that the subject should be awarded a higher focus by politicians.

The MLP Health Report is a representative survey among some 1,800 German citizens and more than 500 doctors. This year, for the first time, representative samples were also taken from the populations in The Netherlands, Sweden and Switzerland. For further details, or to order a copy of the report, please go to: www.mlp-gesundheitsreport.de (German only).