www.azq.de1

Agency forAgency forQuality in MedicineQuality in Medicine(AQuMed)(AQuMed)

Joint InstitutionJoint Institutionof the GMAof the GMA

and NASHIPand NASHIP

Doctors registration and re-licensing in Germany

C. Thomeczek

2nd ENQual workshopHelsinki, 2./3. April 2004

The German Health Care System Basic Elements and Characteristics

• Solidarity

• Self-Government

• Contribution-Financed

• Comprehensive Coverage

• Branched Social Security System

• Benefit-In-Kind Principle

www.azq.de3

SHI + Private 7,6 Mill. Private: 7,2 Mill.

SHI: 72 Mill.

The German Health Care SystemInsured Persons

Update: 1998SHI = Statutory Health

Insurance

www.azq.de4

The German Health Care System (Catalogue of) Benefits

The Social Code Book V (SGB V) guaranties the insured what is

• sufficient (ausreichend)• necessary (notwendig)• useful (zweckmäßig)• economic (wirtschaftlich)

Articles 12, 28, 35, 70, 72, 92, 126,135, 139

www.azq.de5

German Statutory Health InsuranceParticipants and Money Flow

50 %

50 %

sicknessfund(s)

contribution

Assoc.of Statutory Health Insurance

Physicians

flat rate/member/qtr

employed physicians

hospitalbudget

based on DRGslump sums and

basic costs

self-employedphysiciansemployers

employees

www.azq.de6

German Statutory Health InsuranceExpenditure

Update: 1998

domestic care € 1.5 bill

spa therapy € 2.4 bill

pregnancy € 2.65 bill

„sickness wages“€ 6.9 bill

remediies and aids € 9.1 bill

dentists € 10.6 bill

drugs € 16.7 bill

ambulatory physicians € 20.35 bill

hospital € 41.15 bill

other € 5.7 bill

total € 117.15 bill

German Statutory Health InsuranceParticipants and Relations(Ambulatory Medicine)

Patient Doctor

Sickness Fund

(N) ASHIP

Right of Treament

Treatment

Remuneration

Right of Payment

MembershipMembershipBenefit Remuneration

www.azq.de8

41%

47%

6%4%2%

public healthstatutory bodies

other fields

hospital

privatepractice

Active Physicians: 292,100

ambulatorycare

Update: Dec. 31,1999

www.azq.de9

Physicians in Germany Membership in Chambers and Associations of Statutory Health Insurance Physicians

employed physicians (hospitals, Institutes, etc.)

employed physicians (hospitals, Institutes, etc.)

doctors in ambulatory care not working with sickness funds

doctors in ambulatory care not working with sickness funds

doctors in ambulatorycare

doctors in ambulatorycare

w/o medicalactivityw/o medicalactivity

leading state healthofficials

leading state healthofficials

in hospitals

in ambulatory care

licensed forhospital outpatient care

licensed asexternal consultant

Chamber of Physicians

(National) Ass of SHI Physicians(National) Ass of SHI Physicians

www.azq.de10

Physicians' Self-governmentChamber of Physicians (Public Body at Law)

1.Public tasks:• professional code and supervision of the profession• postgraduate education• certification of particular training• continuing medical training (voluntary CME-certificate)• quality assurance• ambulatory emergency service• arbitration • registration and membership fees

2. Professional representation and other tasks:• representation in politics and media• statements on draft bills and decrees• expert's reports• support of public health service• publication of a press organ

3. Social tasks• pension scheme• welfare

BÄK HGF-ADGHS 080 12/95

www.azq.de11

Physicians' Self-government(National) Association of

Statutory Health Insurance Physicians (Public Body at Law)1. Ambulatory health care provided under

statutory health insurance:• register of physicians (in ambulatory care)

• admission to the panel (together with sickness funds)

• admission of external hospital physicians

• supervision and auditing

• continuing medical education and quality assurance• ambulatory emergency service

• planning of physician supply

• counselling of physicians seeking to enter the panel

2. Representation and contracts:• representation in politics and media

• global contracts with sickness funds

• distribution of medical fees

• regulations for the distribution of medical fees

3. Social tasks• relief organisation

• press organ

www.azq.de12

Medical Education in Germany

min 6 y

3-6 y

1,5 y

board examinations

postgraduate training

V. 1.

basic medical trainig

2.

3.

optionalpostgraduate training2 y. (no title)

subspeciality2-3 y. (title)

area2 y. (title)

studentAiP

fully licensed doctor

sp

examinations bystate chambers of physicians

AiP: partly licensed doctorSp: specialist or general practioner

V: pre-clinical board examinations1.,2.,3.: board examinations (3 parts)

graduate trainingpractical training (graduate training)specialialisationsubspecialisation, optional training

speciality(title)

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Health-Care-Modernisation-Law (1.1.2004)New Situation

§ 95 d SGB V “CME-Duty”

…every statuatory health physician is obliged to prove … CME-activities regarding the state of the art medical knowledge every 5 years. …voluntary CME-Certificates of the chambers of physicians can be accepted….

…if the physician doesen´t fullfill his obligation, his payments will be cut….

§ 137 (1) SGB V …(QA in hospitals)

The Joint Federal Commission … defines criteria for CME all board certified physicians in hospitals have to fulfill every five years

BÄK HGF-ADGHS 080 12/95

www.azq.de14

Health-Care-Modernisation-Law (1.1.2004)New Situation

before 1.1.2004• CME part of professional law goverend by the Chambers of

Physicians (voluntary CME-Certificate)• for certain procedures certificates required for SHI-physicians

(certification by [N]ASHIP)

after 1.1.2004• CME for SHI-Physicians and board certified hospital physicians

defined by Joint Federal Commission • Joint Federal Commission consists of

– (N)ASHIPs, – the German Hospital Federation, – Assosiation of Sickness Funds

• Procedures of the JFC have to be approved by the Federal Ministry of Health

BÄK HGF-ADGHS 080 12/95

www.azq.de15

Thank you !

In life there are no solutionsThere are only forces which are in motionYou have to generate themAnd the solutions will follow.

Saint Exupe'ry