How can we fix healthcare

Health system: reform instead of repair

Dr. med. Ellis Huber

A fundamental reform of the health system is essential. In the dispute between the politicians, the doctors and the pharmaceutical lobby over health care reform, however, it is primarily about money. Rather, patient protection and health promotion should be in the foreground.

Our health system is in crisis: health insurance contributions are becoming more and more expensive, doctors are fighting for their budget,

the soulless use of apparatus and drugs determines the therapy. Successful methods of empirical medicine and natural healing methods, on the other hand, are neglected. In addition, health promotion and prevention are neglected. In addition, there is growing concern about the excesses of ethically questionable high-tech medicine.

Greed for profit dominates social responsibility

Everyone involved knows that a fundamental renewal is imminent. Health Minister Ulla Schmidt seems helpless because she is not allowed to tackle a fundamental solution. Because the Chancellor wants peace on the health front until the elections next year. The medical lobby and the pharmaceutical industry are more and more aggressive and ruthless in their "more money for me" policy. They put their selfish interests above the common good; there is a lack of healthy levels of social responsibility.

Many doctors and members of the healing and nursing professions are calling for a fundamental rethink. They want to practice their profession in an ethically responsible manner and with professional competence. The aim is to put a really modern nursing and health promotion into practice. But they are hindered by excessive administrative regulations. In addition, there is a corrupting fee system. Because which therapy the doctor decides on depends more on his material advantages than on the really necessary care for the patient. Today's doctors use computed tomographs and other medical technology instead of fulfilling their social responsibility. Profit interests have long overgrown the ethics of healing.

Farewell to two-tier medicine?

Many healthy, high-income earners are now leaving their statutory health insurance and switching to private providers. There they usually get better benefits with cheaper contributions. On the other hand, those with compulsory insurance can hardly have a say in the choice of therapy method. We have to say goodbye to this system of two-class medicine. What we need is a combination of compulsory solidarity insurance for everyone and private coverage for individual needs. Statutory insurance must be freely selectable and socially graded. Above all, it must protect the weak, such as the chronically ill or the elderly. This standard social care is based on people's needs, that is, it ensures medical services that are really useful and economical in the event of illness, regardless of individual needs.
Excessive requirements and personal wishes cannot be taken into account here. Many a common cold can be treated better with a few days of rest than with expensive medication at the expense of the community of solidarity. And who z. B. wants to insure against impotence or require optical corrections of his teeth, must take out a private insurance. This competition promotes innovations in the art of healing and the patient's right to self-determination. Critics complain that this creates a two-class medicine in which only the rich can afford special services. But it is a myth to believe that a society's inequality in health care can simply be undone. The life expectancy of a wealthy person is always higher than that of a miner.

It is about social, humane and ecological medicine that focuses on its central task: to heal sick people and to maintain and promote health. Together with critical medical organizations, consumer advice centers, but also health insurance companies and the pharmaceutical industry, the Securvita company health insurance fund has developed a reform concept. The 6-point program contains concrete steps and long-term goals for a healthcare system of the future.

1. Recognition of tried and tested healing methods
So far, the health care system has been too one-sidedly oriented towards conventional medicine. The limited horizon of conventional science has pushed a holistic and psychosocial understanding of health to the edge. Naturopathic treatments and all other healing methods are still excluded, although their benefits have long been scientifically proven.
In the future, tried and tested healing methods from the most varied of medical directions are to stand side by side on an equal footing. Medicine, recognized naturopathic methods, psychotherapy, social medicine and other proven therapeutic directions are to be treated in the same way by law.

2. Flat-rate fees for doctors
So far, the fee system for outpatient doctors has been designed in such a way that it virtually challenges corruption and manipulation in billing. Many doctors today are more concerned with billing figures and the utilization of their devices than with their patients. Medical decisions are often linked to the amount of one's own income.
In the future, doctors should receive an appropriate flat fee that is based on the time spent in care. Experience has shown that time-based fees combined with continuous, results-oriented quality management are best suited to assess complex services in a fair and motivating manner. Time fees give doctors the freedom to pursue their actual profession and take care of the health of their patients holistically. They need to have enough time for their patients without their own fees depending on it.

3. No profit-making at the community's expense
So far, industrial sectors such as tobacco, mineral oil or alcohol producers have benefited from products that are harmful to health. However, the financial consequences for the health system are burdened on the solidarity community.
In future, therefore, the polluter pays principle must be implemented consistently: Anyone who benefits from the damage to the health of others must be responsible for verifiable financial consequences. One of the most effective means are special levies on health-endangering products that are clearly identified as such and their effects can be quantified. The taxes for tobacco, alcohol and other disease-causing products are to be paid to a fund for health promotion to relieve the contributors. The individual insured can thus influence their contribution to solidarity insurance through their personal lifestyle.

4. Promote patient rights and independent counseling
So far, the relationship between patients and their doctors and their health insurance company has been characterized by one-sided dependency. The model of an informed, responsible and responsible patient fails due to the lack of information and service transparency.
In the future, high-quality information on health care must be prepared in a user-friendly manner and generally accessible. For this purpose, independent patient centers and consumer health advice must be created and financed. The responsible patient needs an appropriate infrastructure in order to be able to assert his needs and interests. Patient protection needs to be expanded. This requires the doctors and medical services to be obliged to provide explanations and information. The legal position of the patient must be clearly strengthened, e. B. also through stricter criminal law for medical misconduct.

5. The family doctor principle must be expanded
So far, patients - especially the chronically ill - have often been wandering through the care system for years. They become the object of lucrative but questionable medical offers. Individuals in need look in vain for reliable and trustworthy accompaniment or support. The strengthening of general practitioner care envisaged by the government is not sufficient.
In the future, the importance and value of general practitioner work will increase. The modern family doctor - in practice this can also be an internist, gynecologist or pediatrician - takes on the task of individual case management in the health system of tomorrow. In practice this means that he organizes the most meaningful and best help for the individual sick and needy. The treatments should always be oriented towards the patient and not according to what is most profitable for a doctor's practice, a social station or a hospital.

6. Strengthen health promotion and social responsibility
So far, the health system has not been geared towards the methods and possibilities of health promotion. The medical services produce dependency instead of autonomy for the patient. The lobby of the professions and institutions places selfish interests above the common good.
In the future, health promotion must become the basis of health policy decision-making processes in accordance with the principles and goals of the Ottawa Charter of the World Health Organization (WHO): The goal of modern healing and human nursing is the autonomy of people, i.e. their self-determination and independent life management despite physical, mental or social handicaps. The benefits and effects of health promotion offers, like all other health services, must be made transparent and publicly verifiable. To this end, joint control institutes are to be set up to check the quality of the measures and services. The results should be published regularly in a health report.

Tomorrow's health medicine

A redesign and radical simplification of the health insurance system is necessary - with compulsory insurance for everyone and free choices for everyone. The solidarity-financed "health insurance" offers basic care at a high level with all the aids that are effective in the event of illness according to the latest scientific knowledge. Individual supplementary insurance covers services that go beyond the standard care, such as Viagra-supported potency aids, head physician treatment or lifestyle medication.

Statutory and private health insurance are to be legally equated and the previous separation is to be abolished. The "health insurance companies", together with the medical bodies, are tasked with ensuring health care. At the same time, they must be given the opportunity to design additional services for their insured persons and to agree contractual arrangements with medical supply networks. This model has been used in Switzerland for years. Instead of choosing between all doctors, patients are only allowed to choose between the contracted doctors and clinics of their insurance company. Such a structure ensures a much more reasonable balance between individualism and social solidarity than the current structure.

Health care reform affects a central core of the common good. The problems are too complex to leave the solution to individual lobby groups and interest groups. The necessary fundamental reorganization needs a politically convincing and sustainable vision.

Source: Huber, E .: UGB-Forum 5/01, pp. 242-245

This article is taken from the UGB archive.

We would like to point out that the content may have to be re-evaluated due to new scientific findings.