Healthcare: another thing that the Germans just do better

Germany has rejected restrictions on doctors visits.

Recent Conservative ideas to restrict the number of GP visits in a year may be discounted as too controversial. But with the concept of universalism in health and welfare under threat we should not be so complacent. This is another area where we should follow the current trend of noting what has happened in Germany: consultation fees for visiting the doctor were abolished in Germany on 1 January 2013.

Co-payments, as they were called, of €10 if you visited the doctor in any given quarter or if you went to a specialist without a referral, were introduced by Schroder’s government in 2004. Addressing similar concerns to the NHS at present on health costs and the waste of doctors’ time on trivial conditions it was thought, at the time, to be a good idea by all the main parties in Germany. It was supposed to deter the practice in Germany’s compulsory health insurance system of patients hopping from specialist to specialist. They also thought it would bring in approximately €2bn per year.

Once in opposition the Social Democrats (SPD) and Greens turned against the idea of co-payments. As you would have predicted the charges deterred many people from going to the doctor. So it is obvious that the cost in dealing later with deteriorating conditions and in personal misery was great. Even on the projected revenue the German government did not meet its targets. When the abolition of co-payments was debated in the Bundestag last November the Financial Times Deutschland reported that medical practices spent approximately 120 hours a year collecting the fee, a total administrative cost of €360m. Once it came to a vote at the end of last year – coincidentally on the historic date of 9 November – the ruling conservative-liberal coalition (CDU/CSU and FDP) also changed their minds and the Bundestag voted unanimously to abolish the charge.

Could co-payments be introduced in Britain? The idea could be sold as a fairer method than restricting the number of GP visits per patient, it would be said "only those who can afford to pay will have to make this small contribution". But people of all income brackets have commitments to meet, whether it is a mortgage, rent or bills and any fee, no matter how small will deter people from seeking medical help. For those with long-term conditions the need to see your doctor regularly is clear. For the rest of us, also, we need to see the doctor when we have concerns. We may dismiss our niggling symptoms, but we will all get something serious eventually and it may happen sooner if, being human, we decide to spend our tenner on something other than going to the doctor for a trivial matter.

I would suggest that following recent top-down healthcare reforms it is only a matter of time before a formal proposal on GP visits is made – the Tory idea on restricting the number of visits is just to test the water. Universalism has not been defended but is a sound principle. It is more straightforward, we all contribute (even those on out-of-work benefits pay VAT) and we all benefit. The bureaucracy of means-testing is avoided. The case for the better-off benefiting is clear, we are all part of the community and the costs can be recouped by looking at the tax paid by the better-off. In terms of GP visits this is another case where we can learn from the way the Germans do things – a mistake was made but they reconsidered it and put it right.

Photograph: Getty Images
Photo: Getty
Show Hide image

Jeremy Corbyn secures big victory on Labour's national executive committee

The NEC has approved rule changes which all-but-guarantee the presence of a Corbynite candidate on the ballot. 

Jeremy Corbyn has secured a major victory after Labour’s ruling executive voted approve a series of rule changes, including lowering the parliamentary threshold for nominating a leader of the Labour party from 15 per cent to 10 per cent. That means that in the event of a leadership election occurring before March 2019, the number of MPs and MEPs required to support a candidate’s bid would drop to 28. After March 2019, there will no longer be any Labour MEPs and the threshold would therefore drop to 26.

As far as the balance of power within the Labour Party goes, it is a further example of Corbyn’s transformed position after the electoral advance of June 2017. In practice, the 28 MP and MEP threshold is marginally easier to clear for the left than the lower threshold post-March 2019, as the party’s European contingent is slightly to the left of its Westminster counterpart. However, either number should be easily within the grasp of a Corbynite successor.

In addition, a review of the party’s democratic structures, likely to recommend a sweeping increase in the power of Labour activists, has been approved by the NEC, and both trade unions and ordinary members will be granted additional seats on the committee. Although the plans face ratification at conference, it is highly likely they will pass.

Participants described the meeting as a largely low-key affair, though Peter Willsman, a Corbynite, turned heads by saying that some of the party’s MPs “deserve to be attacked”. Willsman, a longtime representative of the membership, is usually a combative presence on the party’s executive, with one fellow Corbynite referring to him as an “embarrassment and a bore”. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.