How doctors and the public view the healthcare system

Healthcare Monitor shows changes in ideas about entitlement

The German healthcare system lacks transparency. Too little is known about how people experience medical care, what they want and need as funders and users of the healthcare system, and what they think of planned or already implemented reforms. And little information exists about whether primary care physicians and specialists see a need for reform and whether they are open to change. To fill this knowledge gap, in 2001 the Bertelsmann Stiftung decided to survey the general population and physicians at regular intervals.

With its "Gesundheitsmonitor" (Healthcare Monitor), the Bertelsmann Stiftung provides political, academic and other leaders with regularly updated, objective information on outpatient care in Germany. The foundation has been surveying a cross-section of the population every six months since 2001 about their experiences with the healthcare system, their attitudes toward healthcare reform and their opinions on where change is needed. Now, for the first time since the surveys began, the results are indicating a shift in attitudes toward entitlement: an increasing number of respondents agree that statutory health insurance programs should provide comprehensive base-level care, with smaller individual risks being covered as a matter of personal choice.

The findings from the Healthcare Monitor help close the gap when it comes to information on healthcare and health policy. They are also valuable input for creating reforms that both medical professionals and the public are willing to support. In developing new approaches, the Bertelsmann Stiftung makes use of a network of experts, who come together to discuss results from the Healthcare Monitor. To date, the foundation has queried over 24,000 members of the public and over 2,500 doctors on over 150 issues relating to healthcare, making the Healthcare Monitor one of the largest of its kind in Germany.

Findings from the survey are communicated to target groups via a number of channels, including books, quarterly newsletters, articles in professional publications, health policy seminars, presentations at conferences and press releases, as well as television and radio interviews.

The tool: Neutral, timely, versatile

What distinguishes the Healthcare Monitor from other surveys about outpatient care? First, as a neutral institution, the Bertelsmann Stiftung can conduct impartial surveys and use the findings to develop independent proposals for reform. Second, the twice-yearly surveys of the general population provide up-to-date information, such as feedback on the immediate effects of reforms. Third, the survey's design makes it possible to analyze changes occurring over time in outpatient care and in the public's attitude.

"Our primary goal is to make the survey results available to government officials and Germany's health insurers," says Dr. Brigitte Mohn, member of the Bertelsmann Stiftung Executive Board. "This gives them a solid, definitive and independent basis for improving the German healthcare system from the perspective of those who actually use the system."

The 2008 Healthcare Monitor was released in November 2008.