family physician centred models_weigeldt
TRANSCRIPT
-
8/9/2019 Family Physician Centred Models_Weigeldt
1/12
- Ulrich Weigeldt -1
health is our issue
Ulrich Weigeldt-Chairman
Familiy Physician centred models (HZV)
08. April 2010
- Ulrich Weigeldt -
Population structure of the U.S.A. (2010)
-
8/9/2019 Family Physician Centred Models_Weigeldt
2/12
- Ulrich Weigeldt -
Population structure of Germany (2010)
- Ulrich Weigeldt -
Demographic change
citizens in Germany, who are older than 60years:
1991 20,4%
2007 25,3%
-
8/9/2019 Family Physician Centred Models_Weigeldt
3/12
- Ulrich Weigeldt -
Multi Morbidity
More than 50% of all people with chronic diseases suffer ofmore than one chronic disease (u.a. Wu, Green, RAND Corporation 2000)
prevalence by general practitioner is about 30%
- patients over 80 years: circa 80%
- patients over 60 years: circa 60% (v.d. Akker 1998)
minimum of five physical diseases
- patients over 70 years: circa 88% (BASE 1998)
multi morbidity and multiple medication- 56 % of patients over 70 years take 5 or more different drugs
(BASE 1996)
Those with lower socio-economic status suffer much earlier andmore frequently from multi morbidity (Sachverstndigenrat 2001)
5
- Ulrich Weigeldt -
Chronic disease consumption of resources
20% of the insured with one or more than one chronic
diseases cause 80% of the costs in the german healthsystem(Bertelsmann Stiftung 2005)
6
-
8/9/2019 Family Physician Centred Models_Weigeldt
4/12
- Ulrich Weigeldt -
Consequence:
This population has a growing need ofprimary care physicians
7
- Ulrich Weigeldt -
Shortage of family physicians / GPs- relatively and absolutely
* ab 1996 auf Grund der Entscheidung zur hausrztlichen Versorgung Quelle: Bundesarztregister der KBV, bis 1992 alte BundeslnderFolie0133, 032007
Jahr
70
1988 1990
Anteil
in %
1996 19981994 20021986 1992
60
40
20
50
10
30
1980 1982 1984 2000 2004 2006
49,4
35,0 35,2 35,5 35,635,9 36,4 37,0
37,6 38,0 38,639,2 39,9
40,7 40,3 41,341,9
45,2 45,447,5 47,6 47,8
52,252,452,554,654,8
58,158,759,759,360,1
60,861,462,062,463,0
63,664,164,464,564,865,0
50,6
48,5
51,5
49,9
50,1 50,1
49,7
50,3
49,3
Fachrztliche Versorgung Hausrztliche Versorgung*
50,7
49,9
Specialsts vs. GPs
-
8/9/2019 Family Physician Centred Models_Weigeldt
5/12
- Ulrich Weigeldt -
Average age of German physicians
(out-patient care)
- Ulrich Weigeldt -
Shortage of primary care physicians
About 50% of primary care physicians are 50+ yearsold!
Students need about 10 years to be a familyphysician
The gap between need and supply grows
-
8/9/2019 Family Physician Centred Models_Weigeldt
6/12
- Ulrich Weigeldt -
Closing the gap?
11
There is no solution within thetraditional system
- Ulrich Weigeldt -
Traditional organization of statutoryout-patient care in Germany
GemeinsamerBundesausschuss
KassenrztlicheBundesvereinigung
GKV -Spitzenverband
Patient-representatives
DeutscheKrankenhausGesellschaft
Sickness funds1234
... Ca. 150
KassenrztlicheVereinigungen
123
....17
Insured persons...72 Mio
Family physicians50 000
specialist80 000
Fond
Contribution
-
8/9/2019 Family Physician Centred Models_Weigeldt
7/12
- Ulrich Weigeldt -
Traditional organization of statutory
out-patient care in Germany
GemeinsamerBundesausschuss
KassenrztlicheBundesvereinigung
GKV -Spitzenverband
Patient-representatives
DeutscheKrankenhausGesellschaft
Sickness funds123
4... Ca. 150
KassenrztlicheVereinigungen
12
3....17
Insured persons...72 Mio
Family physicians50 000
specialist80 000
Fond
Fee forservice -variable
Morbidityorientedpaymentper head
Contribution
- Ulrich Weigeldt -
Change organization of statutoryout-patient care in Germany
GemeinsamerBundesausschuss
KassenrztlicheBundesvereinigung
GKV -Spitzenverband
Patient-representatives
DeutscheKrankenhausGesellschaft
Sickness funds1
234
... Ca. 150
KassenrztlicheVereinigungen
123
....17
Insured persons...72 Mio
Family physicians50 000
specialist80 000
Fond
Fee forservice -variable
Hausrzteverband
Contribution
-
8/9/2019 Family Physician Centred Models_Weigeldt
8/12
- Ulrich Weigeldt -
Present situation
Fragmented system
Too much bureaucracy
Poor Coordination and Communication
No constant calculable income
Less money for primary care physicians
- Ulrich Weigeldt -
Alternative reimbursement
Direct Contracting
with sickness funds:
The Bierdeckel
-
8/9/2019 Family Physician Centred Models_Weigeldt
9/12
- Ulrich Weigeldt -17
Managing medical costs
Sickness funds are able to negotiate price discounts formedication
To re-finance our contract we support those discountcontracts with the pharmaceutical industries
We created an easy to handle IT traffic-light scheme,embedded in the doctors IT-System
And it works!
- Ulrich Weigeldt -18
-
8/9/2019 Family Physician Centred Models_Weigeldt
10/12
- Ulrich Weigeldt -19
- Ulrich Weigeldt -20
-
8/9/2019 Family Physician Centred Models_Weigeldt
11/12
- Ulrich Weigeldt -21
Aims of our new system
We need to focus on solutions to patients problems
We need more time for continual medical educationinstead of wasting our time with administration
We have to be paid adequately
Young colleagues must be guaranteed the maintenance
of a professional perspective!
- Ulrich Weigeldt -22
Who we are:Deutscher Hausrzteverband
The association of German primary care physicians will celebratethe 50th anniversary in autum 2010
The Deutscher Hausrzteverband is federally organized, thereare 17 regional associations with the physicians as theiremembers
With altogether 34 000 members we are the biggest medicalprofessional organization in Europe
More than 50% of German family physicians gave us themandate to negotiate and sign contracts with sickness funds
We founded a cooperative to process the contracts in 2004(HVG = hausrztliche Vertragsgemeinschaft e.G.), membersare primarely the regional associations
-
8/9/2019 Family Physician Centred Models_Weigeldt
12/12
- Ulrich Weigeldt -
Thank you for your attention