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- 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)

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Population structure of Germany (2010)

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Demographic change

citizens in Germany, who are older than 60years:

1991 20,4%

2007 25,3%

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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)

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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)

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Consequence:

This population has a growing need ofprimary care physicians

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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

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Average age of German physicians

(out-patient care)

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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

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Closing the gap?

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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

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- 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

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Present situation

Fragmented system

Too much bureaucracy

Poor Coordination and Communication

No constant calculable income

Less money for primary care physicians

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Alternative reimbursement

Direct Contracting

with sickness funds:

The Bierdeckel

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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!

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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!

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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

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- Ulrich Weigeldt -

Thank you for your attention