Jens Holst
Germany is facing increasing challenges to safeguard universal access to quality health care since the provision of medical services in rural areas is shrinking. International evidence provides two important lessons learned: strengthening primary health care can contribute to reducing the undesired effects of social and demographic transition; and tax-borne or government healthcare systems are more effective in promoting primary health care. This paper argues that structural conditions in the healthcare sector as such and in medical faculty prevent decision makers from effectively reacting either through more adequate contractual arrangement between the various stakeholders of the corporatist system or by enforcing a more suitable education of health professionals. While innovative models of healthcare provision and financing inevitably clash with vested interests, the reforms needed in medical training challenge the current design and prevailing incentives of medical schools. Beyond convincing concepts, strong political will be indispensable for implementing the reforms needed for ensuring countrywide access to health services.