title: [German experience of planning medical installations].
abstract: Since the 19th century, Germany has adopted the Bismarckian model: the medical doctors in private practice provide ambulatory care to the insured people (nearly all the population) and are paid by (public) insurers on a fee-for-service basis. The country introduced in 1993 a large-scale reform composed of several steps: (i) delimitation of geographic areas having similar characteristics; (ii) calculation for each area various physician/population ratios, each related to a specialty; (iii) if the ratio of a specialty in an area exceeds the average national ratio (of the specialty) by 10% or more, the doctors of the specialty are not allowed to set up their office in the area; (iv) if the ratio of a specialty in an area is lower than the average national ratio by 10% the area is "open". After a decade, one can say that the reform has succeeded in curbing the growth in the numbers of medical doctors. Today, there is nearly no possibility for a medical specialist to set up a private office, unless he/she accepts to practice as GPs or to succeed to an other colleague of his specialty. As a matter of fact, many areas are still open to GPs. The medical profession is aging and the young graduates are not motivated to set up office. The country may possibly go down from oversupply in the 80's to medical manpower shortage in the next decade.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kopetsch
mesh_terms: D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration; D005858:Germany; D006801:Humans; D007883:Legislation, Medical; D010820:Physicians / Q000600:supply & distribution*; D011331:Private Practice / Q000331:legislation & jurisprudence / Q000458:organization & administration; D011365:Professional Practice Location / Q000331:legislation & jurisprudence*; D013038:Specialization