Why lack of time and cost pressure in health care can become expensive
A general practitioner in Austria can take just 5 minutes for a patient on average. The reason for this is the lack of doctors and cost pressure. In this blog post you can read why the focus on efficiency in health care not only reduces the quality of medical care, but can ultimately become expensive for society as a whole.
In order to treat a disease successfully, it is necessary to know the reason for it. An important part of every visit to the general practitioner is therefore the anamnesis. This is to be understood as the professional requesting of possibly medically relevant information by medical specialists. The anamnesis is therefore an important basis for the diagnosis, on the basis of which the physician can then prescribe a therapy.
Such conversations take time. But general practitioners have very little of that, as the German news magazine Der Spiegel reports: A meta-analysis of 178 studies from 67 countries shows that an average visit to a doctor in Austria takes just 5 minutes. For comparison: According to this study, Ethiopian doctors have just as long time with their patients at their disposal, Sweden ranks at the top with 22.5 minutes ahead of the USA with 21.07 minutes. In Bangladesh, a general practitioner can only spend 48 seconds per patient.
German patients want more time from the doctor
At 7.6 minutes, German doctors have about 50% more time for their patients than Austrian doctors. Nevertheless, the local population considers this duration to be too short. As the Healthcare Barometer 2018 by PwC Germany shows, this duration is simply too short for 45% of respondents. One year before, the proportion of dissatisfied people was still 40%. The Germans are quite satisfied with their health care system overall. For almost 60%, it is one of the three best in the world.
More patients are populating fewer and fewer hospitals shorter and shorter
However, increasing cost pressure and a lack of doctors not only mean that general practitioners have less and less time for individual patients. The time spent in hospitals also decreases. As Der Spiegel reported, the average length of stay in a German clinic in 2015 was only half as long as in 1991. The number of clinics and hospital beds decreased by roughly a quarter in the same period. The number of inpatient stays rose from over 14.5 million in 1991 to more than 19 million in 2014.
When hospital doctors become machines
The fact that this trend towards short stays and cost pressure can have their downsides is shown, for example, by an article in the daily newspaper Der Standard by a doctor from the General Hospital of the City of Vienna (AKH). The physician, who wants to remain anonymous, reports on the compulsion to work off patients in a hospital as efficiently as on an assembly line. There is hardly any time left for a conversation with the relatives of a recently deceased person. Because the next resuscitation is already waiting and the patients in the ambulance have been waiting for 3 hours. "After 24 hours I go finally home, with the fear of having caused humans damage, although it was my dream to do the opposite", writes the hospital physician in its contribution literally and refers to the nine-hour rest time of a truck driver, which this must insert at the latest after 15 hours work.
Performance-oriented remuneration system forces economic action
Günther Jonitz, President of the Berlin Medical Association, told the Frankfurter Rundschau newspaper how important the focus on costs and efficiency in hospitals has become: "Today, a hospital is more at risk if it performs poorly than if it does poorly". The introduction of Diagnosis Related Groups (DRGs) would be responsible for this. This forms the basis for a performance-oriented remuneration system for general hospital services and has been mandatory for all German hospitals since 1 January 2004. The new remuneration system assigns a price to each diagnosis. The health insurance funds no longer pay for every day a patient spends in hospital.
DRG has also created a new profession: the medical controller. This physician has an additional qualification in business administration and ensures that hospital operations are geared more closely to economic requirements. This puts hospitals under pressure to admit as many patients as possible and to carry out lucrative operations themselves. As the Frankfurter Rundschau continues to report, many chief physicians are now also being committed to economic goals or their success-dependent payment is based on a minimum number of operations. An experienced chief physician in surgery told the German daily newspaper: "If a doctor has only managed half of 150 planned spinal surgeries per year by September, then he could already come up with the idea of operating on a patient whom he would otherwise have sent to physiotherapy for two to three weeks.
The best for the hospital is not always the best for the patient
Patient welfare and economic thinking cannot always be combined. The suspicion that hospitals provide medically unnecessary services for economic reasons is obvious and not unfounded: After all, more operations are performed in Germany than in most other European countries. In Austria, "performance-oriented hospital financing" (LKF) has existed since 1997. There are also suspected cases in the Alpine republic that individual hospitals carry out more operations than necessary. However, it is not only hospitals that are suspected of providing unnecessary medical services in order to generate income. Also established physicians are sometimes accused of talking up expensive achievements to both obligation insured and private patients, which bring little to nothing.
Doctors and hospitals become servants of two masters
A system that, like the LKF in Austria and the DRG in Germany, rewards individual medical services and is not geared to healthy people as a whole, but promotes the criticized practices of hospitals and doctors. Both are thus the servants of two masters: on the one hand, they must offer their patients the best possible therapy. On the other hand, they are encouraged to act in an entrepreneurial manner and naturally strive to achieve the highest possible revenues with the least amount of resources.
Admittedly, a society as a whole must always keep the costs of its healthcare system under control. But it is precisely the performance-oriented billing of individual medical services that could lead to higher overall health care costs. Because operations are carried out that would actually be unnecessary. Because family doctors who hardly have time to listen to the patient and investigate his medical history tend to make false diagnoses or send their patients directly to expensive specialists. Both lead in the end to the fact that either the patients do not become completely healthy and must be further treated. Or that the path to health becomes longer and therefore more expensive than necessary.
Conclusion: Why lack of time and cost pressure in health care can become expensive
It is in the nature of every human being, every living being, to achieve the maximum with the least possible use of resources. If a system does not reward performance, then it is automatically inefficient. A performance-oriented remuneration in health care is not a bad thing per se. But it causes problems if you only reward parts or even the wrong thing: Although using a new hip joint is complex, it is only part of the solution that a patient expects from the healthcare system. The patient wants to be able to move again with as little discomfort as possible. And this is exactly what the health system should pay physicians and therapists for.
Born in Essen, Germany and raised in Münster, Germany. At LEAD Innovation she works as an Innovation Manager and is therefore responsible for the successful handling of projects.