Modelling the ambulant health-care sector in Germany

The health-care sector in Germany is highly regulated. It provides ambulant and in-patient services. On the ambulant side, the National Association of Statutory Health Insurance Physicians (NASHIP) and the regional Associations of Statutory Health Insurance Physicians (ASHIPs) control the labour market for physicians: they determine the number, type and locations of medical practices in Germany relying on a demand-oriented planning method called “Bedarfsplanung”. A model that equally considers supply and demand side of the medical market can improve this planning process. Only with the concurrent modelling of both market sides a supply tailored to suit the market need of medical services can be achieved. Demand depends on the size and the age structure of the population. With increasing age the probability and the number of diseases increase. Moreover, older people show different kind of diseases than younger people. The number and specialisation of physicians should hence be adapted to demographic change. This is a long-term process, because medical doctors pass a long training, starting with academic studies and ending with medical specialisation. The latter is a necessary precondition for working in the ambulant sector. Within the research project QuMed a comprehensive model was constructed that considers the supply of and the demand for physicians in great detail. It encompasses the whole medical market, i.e. the ambulant and in-patient side. The data basis consists of official data from the Federal Statistical Office and the German Medical Association as well as special data with restricted access from the ASHIPs and the federal registry of physicians. The supply side is modelled using a stock-flow-approach including the complete professional life of a physician. The stock is given by the existing number of physicians registered in the data bank of the federal registry of physicians and the German Medical Association. The inflow of medical specialists is estimated considering the number and age structure of students and the composition of the complete group of physicians (ambulant, in-patient and others). The outflow depends on the age structure of the physicians. Changes between both sectors, ambulant and in-patient, are allowed for (given the specialisation condition) and they are used to equalise possible shortages in the ambulant sector. The demand side depends on demographic change and differentiates between age, sex and indications (choice of medical specialist) of patients. Combining demographic information with billing data collected by the ASHIPs (number of patients and cases treated by 24 different specialists) for the ambulant sector as well as health statistics (Federal Statistical Office) for the in-patient sector the future demand for medical services can be projected. Thus, medical specialties that profit from ageing (e.g. urology) or are faced with a diminishing need (e.g. paediatricians) can be identified. Comparing demand and supply helps to determine shortages or sectors with a sufficient number of specialists so that the planning process can be adapted and improved. Moreover, competing relations between ambulant and in-patient sectors for specialists can be detected. First results show, that ageing has a clear impact on the future needed specialisation of physicians. The applied method provides the opportunity to enhance the planning of the medical market, to identify undesirable trends and to calculate simulations for impact analysis.