The shortcomings of the regulatory state and its corporate actors in allocating resident physicians in rural areas in Germany
Abstract as pdf
Corresponding Author:
Andrea Futterer
Eberhard Karls University of Tübingen Germany
andrea.futterer@uni-tuebingen.de
Author(s):
The German health care system has temporarily prevailed during the crisis, not least due to its decentralized health infrastructure. However, there are several shortcomings leading to supply problems even prior to the pandemic. The ambulatory branch faces shortfalls in the supply of resident physicians, in particular in structurally underdeveloped, rural areas. How do these come about?
Several factors come into play: Roughly a third of resident physicians will likely retire within the coming years. The younger generation has not only become predominantly feminine but has undergone a change in envisioning work life. On the one hand, flexible working conditions, preferably in an employment relationship, are a key request. Additionally, studies show a growing want for soft location factors such as childcare, cultural offerings and employment for life partners. The patients, on the other hand, are similarly affected by demographic changes. Older patients are increasingly dependent on continual access to treatment (multimorbidity). These developments meet rather unfortunate structural conditions in various rural areas. Here, austerity politics have “de-infrastrucuralised” municipalities, which, as a result, are facing brain drain. It is, hence, becoming harder to mobilize successors for outgoing physicians. The total number of medical students is growing since the 1970s and ranks as one of the highest in the world. However, not only are graduates increasingly seeking work in non-curative fields, but the state-regulated allocation practice of physicians is leading to misallocation.
The ambulatory branch has long been organized in a corporatist manner, meaning the state delegates the planning and organization of ambulatory care to the association for resident practitioners and the health insurance companies. They come together and negotiate in joint self-governing bodies. This regulatory structure has in light of the financial crisis of the 1970s and increasing competition-oriented restructuring of the health care system undergone a substantial transformation in the direction of competitive corporatism. Its effects heavily influence the relationships between the actors and their strategic rationales. Political-institutional processes aiming to enclose respective supply shortages, namely the health care reforms of the last two decades, have predominantly fallen short of expectations.
The outlined dilemma at hand underlines regulatory malfunctions. It further emphasizes the need for a paradigm shift away from sectoral boundaries and budgetary measures regarding wages and services. Respective claims by diverse social and political actors are to be discussed.
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