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geneva Health insurance worries the Swiss
THE LANCET
DISPATCHES
EISENACH
German doctors unite for the past and the future
rom May 26–31, German doctors will be attending their 100th national congress which takes place this year in Eisenach, the town the congress first visited in 1874. Since then, the Deutscher Ärztetag has become a true “doctors’ parliament”, where 250 elected delegates discuss and vote on all subjects concerning Germany’s 326 800 native doctors. This year’s meeting will be an opportunity to celebrate almost 125 years of German medical history, although the congress, to be opened by Germany’s federal President Roman Herzog, will focus on current professional issues. The story of the Ärztetag goes back to 1871, when Germany was united under the authority of Chancellor Bismarck and Kaiser William I. At that time, Bismarck decided to unify medical and professional regulations in all the former German states and, in 1883, he created the first compulsory health insurance in the world, the principles of which are still in force today. With a new state and a new health insurance, German doctors quickly felt the need to be united, and requested nationwide payment and working conditions. In 1900, the Ärztetag supported the creation of the first doctors’ trade union, the “German doctors’ trade union, for the defence of their economical interests”. Created by the Leipzig physician Hermann Hartmann, the union was renamed the Hartmannbund after his death
F
GENEVA
1923, and is still the biggest German doctors’ trade union with over 60 000 members. Over the years, the Ärztetag became the official voice of doctors, playing the role that it still has today, since no important decision can be approved by German doctors’ organisations without having first been passed by the Ärztetag.
“The Ärztetag remains today the highlight of German doctors’ political and professional activities” The very first Ärztetag was held in Wiesbaden in 1873 and from 1874 to 1880, Eisenach was host to the Ärztetag; after that it was held in a different city almost every year. The list of host cities reflects German history. Some of the cities, such as Danzig (Gdansk) which was host in 1908 and 1928, Breslau (Wroclaw) in 1893, Königsberg (Kaliningrad) in 1902, and Strasbourg in 1905, are no longer part of Germany. The Ärztetag did not convene during World War I nor during the Nazi years, during which time the medical profession was fully reorganised. In 1948, the first post-war Ärztetag was held in Stuttgart, but represented only West German doctors. This continued until 1990; the official “reunification” of German doctors happened in 1991, and, 2 years later, the first Ärztetag to be held in the former German
Democratic Republic since 1932 took place in Dresden. In 1991, to save money, it was decided that, from 1992, the Ärztetag would be held every second year in Cologne, home of the German medical organisations, to avoid the high expenses of this “moving parliament”. Some younger doctors have also expressed concern that the luxurious Ärztetag gives an obsolete image of “rich doctors” to the public and have requested greater simplicity. The Ärztetag remains today the highlight of German doctors’ political and professional activities. Delegates of official doctors’ organisations and trade unions discuss and vote on all propositions and resolutions that represent the official views of doctors towards the government, and prepare all official guidelines. It is an institution much appreciated by most German doctors, and is also a unique example in Europe of a “doctors’ parliament”. Working with the same rules as a general parliament, the Ärztetag grants proper democratic process for all decisions that are taken in the name of doctors. Celebrations will certainly be taking place in Eisenach this year. But, these must not overshadow the problems of today’s doctors’, such as drastic cuts to health expenditure. For that reason too, the forthcoming Ärztetag will be an important event concerning all doctors . . . just as it was in 1874. Denis Durand de Bousingen
Health insurance worries the Swiss
N
ot a few Swiss are worrying themselves sick over how to meet the cost of health insurance. Far from achieving uniform premiums countrywide, the compulsory health-insurance law, introduced Jan 1, 1996, has had the opposite effect. For many people, charges have about doubled, there are extreme variations between cantons, and an extra 15% average increase is forecast for 1998. In Geneva, at the top of the scale, a person aged 30 can be paying over SwFr350 (£151) monthly, with a self-payment responsibility (franchise) of SwFr300. A proposal to increase the franchise to SwFr800 was vetoed by a thoroughly startled government.
Vol 349 • May 24, 1997
Rejecting suggestions that 65 years be set as the age limit for practising doctors, Hans Heinrich Brunner, president of the Swiss Medical Association, has gone as far as to advocate a 25% across-theboard personnel reduction in all sectors of the medical field, to fight escalating health costs. The three main insurance companies have threatened to arbitrarily reduce their reimbursement of medical, including hospital, charges. Some doctors, obviously alarmed at rising costs, have thought it advisable to enclose with accounts a note saying that they certainly do not expect remuneration in excess of what an insurer pays, and asking the patient to deduct any difference
from the total on the bill. Under the slogan “a halt to exploiting the sick”, a prominent food-store chain, long engaged in combating cartels, has launched an initiative for reducing pharmaceutical prices, which, it claims, could bring down the cost of basic health insurance by 10%. Full-page newspaper advertisements by the chain present a comparison of prices in Switzerland and neighbouring countries, showing that the Swiss are sometimes paying five times more for identical prescribed items. And why, the manifesto asks, do doctors in general avoid prescribing generic drugs? Alan McGregor
1527
DISPATCHES
EISENACH
German doctors unite for the past and the future
rom May 26–31, German doctors will be attending their 100th national congress which takes place this year in Eisenach, the town the congress first visited in 1874. Since then, the Deutscher Ärztetag has become a true “doctors’ parliament”, where 250 elected delegates discuss and vote on all subjects concerning Germany’s 326 800 native doctors. This year’s meeting will be an opportunity to celebrate almost 125 years of German medical history, although the congress, to be opened by Germany’s federal President Roman Herzog, will focus on current professional issues. The story of the Ärztetag goes back to 1871, when Germany was united under the authority of Chancellor Bismarck and Kaiser William I. At that time, Bismarck decided to unify medical and professional regulations in all the former German states and, in 1883, he created the first compulsory health insurance in the world, the principles of which are still in force today. With a new state and a new health insurance, German doctors quickly felt the need to be united, and requested nationwide payment and working conditions. In 1900, the Ärztetag supported the creation of the first doctors’ trade union, the “German doctors’ trade union, for the defence of their economical interests”. Created by the Leipzig physician Hermann Hartmann, the union was renamed the Hartmannbund after his death
F
GENEVA
1923, and is still the biggest German doctors’ trade union with over 60 000 members. Over the years, the Ärztetag became the official voice of doctors, playing the role that it still has today, since no important decision can be approved by German doctors’ organisations without having first been passed by the Ärztetag.
“The Ärztetag remains today the highlight of German doctors’ political and professional activities” The very first Ärztetag was held in Wiesbaden in 1873 and from 1874 to 1880, Eisenach was host to the Ärztetag; after that it was held in a different city almost every year. The list of host cities reflects German history. Some of the cities, such as Danzig (Gdansk) which was host in 1908 and 1928, Breslau (Wroclaw) in 1893, Königsberg (Kaliningrad) in 1902, and Strasbourg in 1905, are no longer part of Germany. The Ärztetag did not convene during World War I nor during the Nazi years, during which time the medical profession was fully reorganised. In 1948, the first post-war Ärztetag was held in Stuttgart, but represented only West German doctors. This continued until 1990; the official “reunification” of German doctors happened in 1991, and, 2 years later, the first Ärztetag to be held in the former German
Democratic Republic since 1932 took place in Dresden. In 1991, to save money, it was decided that, from 1992, the Ärztetag would be held every second year in Cologne, home of the German medical organisations, to avoid the high expenses of this “moving parliament”. Some younger doctors have also expressed concern that the luxurious Ärztetag gives an obsolete image of “rich doctors” to the public and have requested greater simplicity. The Ärztetag remains today the highlight of German doctors’ political and professional activities. Delegates of official doctors’ organisations and trade unions discuss and vote on all propositions and resolutions that represent the official views of doctors towards the government, and prepare all official guidelines. It is an institution much appreciated by most German doctors, and is also a unique example in Europe of a “doctors’ parliament”. Working with the same rules as a general parliament, the Ärztetag grants proper democratic process for all decisions that are taken in the name of doctors. Celebrations will certainly be taking place in Eisenach this year. But, these must not overshadow the problems of today’s doctors’, such as drastic cuts to health expenditure. For that reason too, the forthcoming Ärztetag will be an important event concerning all doctors . . . just as it was in 1874. Denis Durand de Bousingen
Health insurance worries the Swiss
N
ot a few Swiss are worrying themselves sick over how to meet the cost of health insurance. Far from achieving uniform premiums countrywide, the compulsory health-insurance law, introduced Jan 1, 1996, has had the opposite effect. For many people, charges have about doubled, there are extreme variations between cantons, and an extra 15% average increase is forecast for 1998. In Geneva, at the top of the scale, a person aged 30 can be paying over SwFr350 (£151) monthly, with a self-payment responsibility (franchise) of SwFr300. A proposal to increase the franchise to SwFr800 was vetoed by a thoroughly startled government.
Vol 349 • May 24, 1997
Rejecting suggestions that 65 years be set as the age limit for practising doctors, Hans Heinrich Brunner, president of the Swiss Medical Association, has gone as far as to advocate a 25% across-theboard personnel reduction in all sectors of the medical field, to fight escalating health costs. The three main insurance companies have threatened to arbitrarily reduce their reimbursement of medical, including hospital, charges. Some doctors, obviously alarmed at rising costs, have thought it advisable to enclose with accounts a note saying that they certainly do not expect remuneration in excess of what an insurer pays, and asking the patient to deduct any difference
from the total on the bill. Under the slogan “a halt to exploiting the sick”, a prominent food-store chain, long engaged in combating cartels, has launched an initiative for reducing pharmaceutical prices, which, it claims, could bring down the cost of basic health insurance by 10%. Full-page newspaper advertisements by the chain present a comparison of prices in Switzerland and neighbouring countries, showing that the Swiss are sometimes paying five times more for identical prescribed items. And why, the manifesto asks, do doctors in general avoid prescribing generic drugs? Alan McGregor
1527