Im heute in der NZZ veröffentlichten „Streitgespräch“ zwischen dem Präsidenten der Aerztegesellschaft, Herrn de Haller, und Bundesrat Couchepain, schliesst dieser mit dem Vorwurf, dass sich die Aerzte heute kaum mehr als liberaler und vom Staat unabhängiger Berufsstand verstehen.
Das, Herr Couchepain, liegt I do not think the doctors, but most unfortunate Insurance Act of 1996. Refine However, I want the doctors so far as to co-responsibility used and thus the blame must be accused, because she and her big "sin" that in the fifties and sixties of the last century with the box office closed generally applicable collective agreements, this Act only made possible. Because so they destroyed the most important way of free competition, namely the physicians in the. In my view, this competition would be so important because it would make it possible not only to the patient to choose the doctor free, but also determine how much they are willing to fork out for treatment themselves. It would work similarly to the dentist: for a certain treatment, certain Taxpoints determined how much you ask the doctor for every relative cost index would, however, left him. The funds in turn would set for itself a value that would be appropriate for the calculations of the mathematician. With my dentist is a case in point: it states that the relative cost index for CHF 3.90. The office, which hosts the supplementary benefits (I'm known IV - retired), will pay for the relative cost index CHF 3.10. To me have to decide: Is my dentist to me that extra value? I am convinced also, that he charged me without further CHF 3.10, when I would ask him (he does not know or not know that I IV - I am retired). For the physician, mixed bills would be possible, because it would be as it used in practice patients and patients with private insurance. As far as I know, was a doctor earlier hit for one or such an insured 50 to 100% of the specified with the cash Taxpunktwertes do so, and set off thus a general insured who is financially unable to "top pay", the cash fare. Decide means to be free, Mr. Couchepain! (Many of whom I the idea of \u200b\u200ba "free market in health care" setting out, I reply that the physicians would bleed to death in such a system the patients. I believe that every doctor, if he chooses his profession, somewhere in himself a tendency towards social (fellow lichen, or not to company) and would therefore not suck his patients. Furthermore there are also checks, for example by the media (Kassensturz, Ges.heitszeitschriften) or the patient locations. In contrast to the dentists, who are always in short supply, there are large fluctuations among physicians: When I was young, we had a Aerztemangel, today we have to almost speak of a Aerzteschwemme (except for the GPs!). I am firmly convinced that the Aerztedichte would affect the pricing.)
Now you seem to believe firmly, Mr. Couchepain that would arise with the cancellation of the contract coercion more competition. I can not let it backwards and forwards to go through your head and not come to that conclusion.
Let's say: I am registered with a doctor here in Zurich. As he in his pricing is not free, he paid my cash the Tarmedtarif. The contract penalty has fallen, and my doctor get from my office, no contracts, because that it takes about something too expensive or too few well qualified. What do I do? I have to either change the doctor or the box office. So you decide if my doctor qualitativ gut ist oder zu teuer, nicht ich, der Konsument! Woher soll eine Kasse, also eine riesengrosse Institution, besser wissen als ich, ob mir mein Arzt gut tut? Wo, sagen Sie mir, entsteht da mehr Markt, mehr Wettbewerb? Nicht ich, der Kunde, entscheide, wie ich das am Markt als Konsument tue, sondern die Kassen. Aha, das ist gewollt: Mehr Wettbewerb unter den Kassen? ... Und worin besteht der Markt der Kassen? Wir sind der Markt, wir die Kunden. Wir werden umworben. Und die Aerzte? Sie werden zu einem – wie soll man das nennen? – Angebotsverbesserer, zu einem für die Kasse werbenden Aushängeschild. Bei uns haben sie Dr. so und so, ... und bei uns den noch viel besseren Dr. dies und das! Aber die Kassen werden rather, the rates can press without a contract penalty. If they dare, in case one of their stars? Or will they begin to make these stars deals, keep it during checkout when you click the Taxpunktwert? Or is there no more stars, which I define as physicians who are exceptional players, as they exist in every profession and to give. Among the stars in my opinion are also doctors who can best fulfill your patients, because we now know how important for the progression of a disease the doctor - patient - is money. Or should an average be bred, in the economic and quality issues in the middle liegt? Oder bekommt der Arzt seine Anerkennung nicht mehr von seinen Patientinnen und Patienten, sondern von der Kasse? Vielleicht gibt es dann Ranglisten, wie bei den Verkaufszahlen in den Filialen der Detaillisten: Dr. A. behandelte so und so viele Patienten und verursachte nur so und so viel Kosten, gleichzeitig hat er sich durch diesen und jenen Kongress weitergebildet oder dieses und jenes Buch gelesen? Vielleicht kriegen die Sieger ein Diplom, das sie in der Praxis aufhängen können, oder eine Ferienreise geschenkt? Letzteres wäre gar nicht so dumm, wir geraten damit aber in Konflikt mit den Kosten.
Nehmen wir an, ich wäre ein schon älterer, praktizierender Arzt in Zürich: Es gibt bereits ein System, das die purports to measure efficiency of physicians. In this system, I lie because I am very thorough and will take the time for my patients always above average. The contract is now forced to be repealed: I get "scared" and begin my service to shut down in order to come to or even below average. First, I care not, because I was not more thorough person I can be myself, and secondly, I know in the next release of the economics that I'm still up, because not only I got "scared" but with me all other colleagues who are above average. Also, they drove down their performance. This sank der Durchschnitt. Das freut die Kassen und Politiker, denn so werden Kosten gespart. Meine Patientinnen und Patienten kennen mich aber nicht mehr, denn sie spüren, dass ich weniger gründlich an die Sache herangehe, und vermissen meine Gespräche. Wegen diesen gehörte ich vor dem Tarmed, der diese Gespräche aufwertete, übrigens zu denen unter oder im Durchschnitt. Vielleicht werden Sie entgegnen: Wenn sie gut sind, warum brauchen sie einen Vertrag? Mir bleibt die Antwort: Durch das Obligatorium schloss jede und jeder mit einer Kasse einen Vertrag und bezahlt nicht schlecht Prämien dafür. Was sollen diese Menschen bei einem Arzt, den er selber bezahlen müssen? Ohne Vertrag mit mindestens einer Kasse habe ich keine Chance!
Suppose further that I was a young doctor and was in the last months of my training ... say, as general practitioners, so as a family doctor. Once I decide to open a practice, I need first contracts with health insurance, because without that I will never be a bank to borrow the money to set up a practice it is new or renovate the old practice of a colleague and to add new devices . Suppose that in the preferred region I it - once - enough general practitioners, as they near a town is and has a well-organized emergency services with a few assignments per month. Since I have never worked on their own account, Cash can not know how much I want to get them. Since not only I noticed that this region is a good, came forward - we take once - three other colleagues. The insurance companies will take the best. But how do you rate our quality? You drag an information, eg with my current employer, they examine my cards and training - products and they test me in conversations and so on. So how do the staff director of a company. Since the Taxpunktwerte - therefore, the wage - are fixed, I will therefore be an employee of the fund.
An editor, who I respect very, asked me in this context even cynically, " Und was ist denn dabei? Sind angestellte Aerzte weniger wert als selbstständig Erwerbende?“ „Nein,“ antwortete ich ihm, „aber man soll nicht immer von Wettbewerb und freiem Markt reden, sondern die Sache benennen, wie sie ist: Mit dem Gesetz von 1996 schufen unsere Politiker eine Kassenmedizin und mit dem Aufheben des Vertragszwangs verstärken sie diese. Statt staatlich ist unsere Medizin „kasslich“. Wir müssen uns einfach entscheiden, was wir wollen.“
Nur wenn wir den Mut hätten, dieses Gesundheitswesen wirklich zu einem marktwirtschaftlichen zu machen, könnte es in meinen Augen genesen. Es gäbe bei den Aerzten und bei den Spitälern ein freies Gestalten der Preise. want to insure - the patients would decide how they are - even with a mandatory. The patients would choose their fund and to determine how much they are willing to pay for their premium. This would help determine the technical progress, as new equipment would not be introduced where they are invented, but only after a clarification as to whether they can also be employed profitably. And what I think is important: the Treasury would have their premiums to show how much each of us mitbezahlen for elderly patients need, for I am sure most would do so readily and not in a cheap office switch and if so, this would be her decision.
In deciding to come to it, Mr Couchepain: The more I can decide, the more free I am, and the more I can decide, the more power I have. When you break, Mr Couchepain and Parliament forced the contract, move more decision making powers and therefore power of the patients and the doctors, so the actual market for health insurance. I often think, when in power, it's like the energy: The sum is the same if they take away the one and the other is. The funds, which already have too many wars, and even more people at the front, the market, wo sich das aussi sleeps Gesundheitswesen abspielt, wird noch mehr genommen. Und Sie verlangen von den Patienten und mehr PatientInnen Eigenverantwortung und von den Aerzten, dass sie denken und vom Staat liberal werden sollten Unabhängiger!?!
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