www.azq.de 1 agency for quality in medicine (aqumed) joint institution of the gma and naship doctors...
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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)
www.azq.de13
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