Thursday, March 1, 2018

The Arrival of the Master Craftsman

Most political folks believe that the SPD Party vote on the coalition (results come on Monday) will pass, and the new government will fall into play real quick.  The one key element of this government will be the new guy in charge of the health ministry.  CDU member....Jens Spahn.

Spahn is on a short list of people who would replace Merkel (whenever it occurs).  He's also on the lesser favored list of Chancellor Merkel (at least various insiders hint that).

Over the past week, Spahn has come public to state his key three agendas for the future of healthcare in Germany. The topics: rural care (there is a serious perception in Germany that if you live in rural get less than adequate care), lack of nurses, and the odd problem of doctors seeing private health insurance people ahead of the public insurance people.

So to explain these particular problems:

1.  Three avenues exist in Germany for healthcare.  If you make less than a certain amount (it used to be around 40,000 Euro a year), you had no participated in public insurance, period.  For those making over the 40k situation, you could go with no insurance or a private policy.  In general, the private policy folks had a better deal if you were under the age of thirty, and you could find a designed policy to cover certain key very little under out-patient costs.  The private policy folks also paid hefty amount once they got up past fifty years old...more so than the public insurance folks.

But there was one key element.  Private insurance companies tend to pay real quick. That's not so true with the public policy.  So doctors were very happy when a private policy guy showed up and wanted an appointment.  The doctor and his staff knew that they'd get paid within four weeks.

Naturally, there is resentment by the public insurance crowd (amounting to three-quarters of the nation) and that there should be NO dividing line.  Spahn intends to fix this.  Personally, he may think that he can fix it....but the doctors aren't going to be that stupid.  Whatever solution you'll be a fake agenda item and convince people that the trend has been halted.....when its still going on.

2  The rural care.  Well....every single major community in Germany has a major hospital and doctors/surgeons tend to prefer living in metropolitan areas.  No shock there.  The rural regions?  They have hospitals, but to be honest....these are areas where you'd probably not find the top doctors or programs.

You as a German could pick up your bag and get your ticket for care at a major hospital unit....that's not a problem.  But would you want to go and drive a hundred kilometers from your house for some surgery, when you have it within twenty?

Again, it's a perception thing.

3.  Finally...the nursing shortage.  This goes to three key elements. First, crappy respect across the whole sector.  Doctors don't really respect nurses in the same manner that you mind find in the US.  It's partly historical....partly the doctor mindset in Germany....and partly the education factor.  This leads onto the second element....once you get your nurse certificate in are set for the rest of your life.  Even if there are major trends occurring every three years in the will probably not ever attend newer certification seminars or classes.  If you did get enthusiastic? won't lead to better pay, and most nurses don't want to pack up and move every five years.  So you come to the last element....the group of folks wanting to get into the field. It's just not an overwhelming draw in Germany to be a nurse.

The solution?  Foreign nurses.  Yeah. From Czech, Hungary, Poland.  The new immigrants from Iraq and Syria?  There's talk of programs being built to bring a fair number of the immigrants into the field.  Nurses from the Philippines?  Well...yeah, there is a training program sponsored there, with language classes and a visa deal worked out.  It's not a huge number but every year....several hundred make their way into Germany.

In this case, Spahn has a tough problem.  German nurses are realizing their value elsewhere, and quietly leaving (going beyond the border).  He can't change the doctor mindset.  So the only real area is expansion of foreign nurses and maybe creating more certification or re-certification programs.

 The coalition agreement spells out the plan that the SPD agreed upon.  The issue will be....just how far beyond that point will Spahn venture.  The other curious the next two to four years....if Spahn is successful, will this all lead onto him being the Merkel replacement?

Spahn is working against two key women who figure to be the eventual Chancellor. Julia Klockner. (set to become the Minister of Agriculture) and AKK (Annegret Kramp-Karrenbauer), the new CDU Party chief.

There's virtually zero chance that the next Chancellor will go beyond these three names.  So they will be working day and night....trying to get public TV time, and convincing the public of good intentions or positive accomplishments. 

In Spahn's case....he's got a loaded deck and a fair number of problems.  But any repair to the system is better than no repair. 


Anonymous said...

I see the following issues with the German Health System
Lack of staffing due to
- horrible patient:staff ratio
- poor pay
- no career path
- no or little mandatory and advanced professional development to stay up-to-date with the medical/nursing progress

Low quality/patient outcomes due to
- no mandatory health standards which are independently are audited by a authority
- no mandatory registration register and yearly renewal where every health professional has to declare
(a) their yearly hours of practise,
(b) their minimum hours of training, especially their mandatory training subjects, eg Basic Live Support etc,
(c) their ability to perform their profession safely not restricted by any health issues
(d) that no legal case or complaint has been made against their professional conduct or any criminal charges
(e) that they will adhere to the code of conduct as outlined by the registration authority
- removing health professionals who fail to meet those requirements
- Official investigations into all parties involved that harm a patient in their care
- Criminal charges of everybody involved in the harm of a patient their care.

In Germany these things are not or only marginal in place. Requirements to secure Quality are only recommend and left to the provider of health care. Auditing where done is not sufficient.

The doctors lobby have managed to put themselves into a central position of the German Health System claiming they have the right to be not controlled to protect the patients privacy and the freedom of profession. They also managed to create an image of being the crown of the academic professions which selfless acts in the interest of the society and patient, and that they deserve the income they request.
In the common resource competition between nurses and doctors, nurses in Germany never had a chance to create a position as the nurses have in Anglican countries like UK, USA or Australia. Doctors in Germany claim to have knowledge in patient care where they never have been trained for and give instructions on a daily basis to nurses. Nurses in Germany are used to subdue to their low role.
The German society, the legal system and the press is not interested in the failings occasionally discovered in the system.

Anonymous said...

Why is this system lowering the quality in the German Health System and dis-encourages nurses to work in that system?
- Doctors having low contact time with the patients due to their own work load for which they have been trained.
- Nurses are only seen as helper which leads the management to keep the staffing and wages to a minimum. According to the doctors and management there is no serious training necessary as the doctor is managing the health process. Hence to get quickly people from third world countries to train them up.

Other countries like California and Australia has set by law a 1:4 patient nurse ratio as a 1:5 means a 20% higher mortality of a hospital patient. In Germany they come not even close to that kind of discussion.
In England the NHS dictates their quality standards into the private health care sector and is auditing those. Unheard of in Germany. To get GPs to do their minimum training the country banks on quality labels doctors can display if they are happen to do their bit.
In UK and Australia, not sure in the USA, high ranking commissions look into failures of persons/organisations in the health system. Reports like in Germany where registrars in a hospital are not following the consultants order to send a patient to the coronary angiography to make money for the hospital as it is not necessary or there are less harmful investigations possible would trigger a investigation with the consultant most likely being removed from the register. Not so in Germany. The report appears and disappears and the show goes on.

In the UK, USA and Australia, the nurses have the closest contact with the patient. The act here as independent carer within their scope and involve the health team as needed. This is efficient and ensures a high quality and fast response to the patients needs. It also gives nurses the status and sense in their work that is justified.