The interview partnerse
Prof. Dr. Patrick Da-Cruz is a professor of business administration and health management in the School of Health Management at Neu-Ulm University of Applied Sciences (HNU) and the academic director of the MBA program in Leadership and Management in Healthcare.
Prior to joining HNU, Dr. Da-Cruz worked at leading strategy consulting firms in the pharmaceutical and healthcare sectors and held executive positions at healthcare companies both in Germany and abroad.
Hanno Wolfram spent more than 20 years in the pharmaceutical industry, holding positions including sales representative, HR manager, Managing Director for Switzerland, and Area Manager for Europe. Drawing on this experience, he founded the consulting firm Innov8, where he has been leading consulting, change management, and implementation projects in numerous countries for the past 25 years. He is an author, coach, and lecturer at HNU.
What is meant by the concept of a primary care physician, and what is the goal of this model within the healthcare system?
Hanno Wolfram: The core of the “primary care physician” concept is better management of the patient journey. For patients covered by statutory health insurance, seeing a primary care physician is a prerequisite for consulting a specialist. Only the primary care physician grants access to a specialist and refers patients to the optimal care pathway.
The expected outcomes include more targeted appointments with specialists, faster access, and, as a result, increased efficiency in outpatient care. The aging population is considered one of the biggest drivers of costs. Primary care physicians will play a coordinating role, help curb costs, and contribute to improving the efficiency of care.
However, for many people today, the freedom to choose one’s own doctor remains a sacred cow in the healthcare system. A primary care physician system would impose significant restrictions on patients.
What advantages does a primary care physician system offer from the patients’ perspective—for example, in terms of care, coordination, or the quality of treatment?
Hanno Wolfram: In the healthcare sector, as in other areas, there is a lot of talk about patients, but less conversation with them. From a patient’s perspective, at least, I am not aware of any studies on their perceptions, hopes, or fears regarding the primary care system. Here in the south, however, there is a model for the primary care system that is being sought nationwide.
As early as 2008, the AOK, the Association of General Practitioners, and MEDI Baden-Württemberg established the General Practitioner-Centered Care (HZV) program. Nearly 3 million patients have since enrolled in this program. This figure suggests that enrolled patients have voted with their feet in favor of the program.
The medical data and facts regarding the program’s success speak for themselves. The vast majority of indicators—such as uncoordinated visits to specialists without a referral or the number of complications among diabetics—clearly point toward “improvement.” The number of vaccinations has also increased. Nearly 6,000 doctors are participating in this program.
Where do you see the biggest criticisms or risks of the primary care physician model, for example regarding freedom of choice, wait times, or additional bureaucracy?
Hanno Wolfram: As already mentioned, freedom of choice regarding visits to specialists tends to be limited. This applies whenever the primary care physician’s recommendation stands in the way. As a rule, however, this can be considered more of a “luxury problem” affecting only a small number of patients.
Based on the results of family physician-centered care in Baden-Württemberg to date, there should be few criticisms of the primary care model’s structure.
One thing stands out, however: the number of visits to general practitioners is rising significantly. If the future primary care physician is envisioned in the same way as the first HZV contracts in 2008, waiting times for GP appointments will become an even bigger problem. Especially since there are always patients who can’t find a GP at all due to overcrowding. The statement, “We can no longer accept new patients,” sounds far from encouraging and already suggests overload or overwork. There must therefore be alternatives or complementary approaches to in-person visits to the doctor.
In your opinion, is the primary care physician model a sustainable approach for the German healthcare system, and under what conditions would it be effective?
Hanno Wolfram: Given its current funding and incentive structure, our healthcare system cannot sustain itself much longer. “Business as usual” is therefore not an option. The status quo is characterized by “doctor-hopping” and the unregulated wandering of many patients. The pressure on primary care physicians to see patients quickly is mounting, and the treatment pathways they aim to follow—based on clinical guidelines—are being rendered meaningless by patients who have sought the wrong care. As a result, Dr. Google and the like are also contributing to overcrowded emergency rooms.
A primary care system urgently needs more capacity for initial consultations. The primary care system can only become sustainable by exploring new avenues: To achieve this, we must finally begin implementing intelligent digital applications. This will enable us to create new capacity. The term most commonly used in this context is “artificial intelligence.” Whether AI is used as a chatbot for the initial contact with 116117, accessed with a single click in the ePa app, or via a link on the internet: all these options must be made available. This means that the initial contact no longer has to take place at the family doctor’s office.
In emergency rooms across the country, it is already evident today that physician assistants and “care nurses” are taking on important responsibilities, thereby significantly supplementing and expanding the available medical capacity. This applies equally to the stage prior to a primary care physician’s direct involvement as well as to the follow-up after a patient has seen a doctor.
If we were also to implement simple measures such as electronic payments or “annual prescriptions” for patients with chronic conditions, this would lead to greater patient satisfaction. Furthermore, such measures must not allow the gap between statutory health insurance revenues and costs to widen any further. Ultimately, what matters—including for patients—is improved care and significantly greater efficiency in the healthcare system. What is still missing is the political will and an end to silo thinking. I hope that the political will to do so will be strong. The benefits for those involved and affected will be significant if the issue is approached and addressed from a holistic patient perspective. After all, patients do not care about the traditional dividing lines between sectors.
Thank you very much for the interview!
The content and statements presented in the interviews reflect the perspectives of the interviewees and do not necessarily reflect the editorial staff’s position.
