Germans turn to ‘medibus’ as doctors desert villages

As a shortage of doctors and an aging population grips rural Germany, more 'Medibuses' are stepping in to serve locals.

Germans turn to 'medibus' as doctors desert villages
Patients lining up for a Medibus in Nentershausen in Hesse in June 2018. Photo: DPA

For years after the last doctor left the small German village of Weissenborn in the state of Hesse, 79-year-old former mayor Arno Mäurer had to rely on his car to reach the nearest clinic, as a chronic shortage of practitioners gripped his rural region.

But this year a clinic started coming to him.

The “Medibus” is a complete doctor's office in a red and yellow bus that sets up shop in the community of around 1,000 people for a few hours on Tuesdays and Thursdays.

SEE ALSO: Doctor practices should be open later, on weekends: German health insurance

“The day will come when I won't be able to drive any more, so I'll be totally dependent on the Medibus,” Mäurer says.

For the time being, he turns to the mobile practice now and then but still sees his doctor when he isn't completely booked up.

Every week, the bus, set up by the Hesse state medical association, stops off in six villages in western Germany.

As in many areas of western Europe, they are afflicted both by an ageing population and a scarcity of practitioners to take care of them.

On board the Medibus, doctor Matthias Roth saw around 35 patients a day in the summer months, or roughly the same number as a traditional GP's practice, the association says.

Around 70 percent of the patients were more than 55 years old, and 30 percent older than 76.

“It's a full practice, we have everything on board to diagnose and care for patients,” Roth tells AFP, from his chair behind the tiny desk squeezed into the consulting room in the vehicle's rear.

Outside on the town square of Cornberg – population 1,600 – project supervisor Carsten Lotz from the medical association declares the project a “very big success, we're very satisfied.”

Creeping 'medical deserts'

Across Hesse, more than 170 doctors' posts are unfilled, according to data from the medical association.

Even the offer of a bonus of up to 66,000 over five years to those setting up in specific areas has failed to lure enough new blood, while doctors delaying retirement are offered up to 2,000 per quarter.

The shortage is so acute that the Medibus received a special exemption from a general ban on itinerant doctors.

Fearing the initiative might speed up the growth of so-called “medical deserts”, some local officials have resisted the bus, Lotz says.

“It's still our job to bring young doctors to the towns, the Medibus is just there as a top-up” where that isn't possible, he says.

For doctor Roth, it's “a good solution given what's available,” even if it's “certainly not an ideal state of affairs”.

“We aren't competing with local doctors,” he adds.

While waiting for the “miracle” of a new permanent doctor arriving, former mayor Mäurer says the bus “must absolutely be kept going… it's better than nothing.”

Managers for now plan to keep the Medibus going for two years at a total
cost of 600,000.

Europe-wide problem

Europe-wide, the problem of medical deserts is spreading, with falling numbers of generalists, a wave of older doctors heading into retirement and their young successors looking for a more balanced lifestyle.

In the UK, the British Medical Association estimates there are around 2,000 patients for every GP, and rural areas struggle to lure young doctors away from the cities, a spokesman told AFP.

The country's National Health Service (NHS) has offered bonuses of 20,000 pounds (22,500) to newly qualified practitioners setting up in the least attractive areas.

And in France, around eight percent of the population – 5.3 million people – lives in one of the 9,000 municipalities judged to have an under-supply of doctors, according to the French government.

While France has a similar ban on itinerant medicine to Germany's, the medical association has authorized the practice in exceptional cases “in the interests of public health” — with a first mobile unit planned in the central Auvergne-Rhone-Alpes region early next year.

Text by Yann Schreiber.

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What you should know about Germany’s plans to roll out e-prescriptions

Germany is taking a big step towards a more digital-friendly health system, with plans to roll out e-prescriptions nationwide. Here's what you should know.

A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony.
A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

What’s happening?

From January 1st 2022, people in Germany will receive their prescriptions digitally (known in Germany as an ‘e-Rezept’) from healthcare providers.

Patients should be able to get their prescription from their doctor via a QR code sent to an app, which can then be transmitted to a pharmacy. The pharmacy can then let the patient know whether their medicine is in stock (or if they want to order it), and when it is ready for collection. 

This model is to be mandatory for people with statutory health insurance from the start of 2022, replacing the good old paper prescription.

However, the QR code can also be given to the patient by the doctor on a piece of paper if a patient does not have access to or doesn’t want to use a smartphone. 

READ ALSO: The changes around doctors notes in Germany you should know 

How exactly will it work?

In theory this is the plan – you’ll visit the doctor or have a video consultation. After the examination, the doctor will issue you with an electronic prescription for the medication that has been prescribed to you. 

A prescription code is automatically created for each ‘e-Rezept’, which you will need so you can get the medicine at the pharmacy. As we mentioned above, patients in Germany can either open this QR code in the free e-prescription app developed by Gematik and the Health Ministry, or receive it as a printout from the doctor. 

Next, you can take the prescription QR code (either in the app or as a printout) to your pharmacy of choice to get the medication needed.

One of the major differences and timesavers under the new system is that you can also select the pharmacy you want to get the prescription from digitally, order the medication (if needed) and you’ll be alerted when the prescription is ready. You can also arrange to have it delivered if needed. 

A doctor’s signature is not required, as e-prescriptions are digitally signed. 

The aim is that it will save on paperwork, time at the medical office and trips to the pharmacy. 

Some patients have already been receiving digital prescriptions. The ‘e-Rezept’ was tested out successfully in selected practices and pharmacies with a focus on the Berlin-Brandenburg region of Germany. The test phase started on July 1st this year.

Pharmacies and doctors’ offices nationwide have also been given the opportunity to test the new system from the start of December. 

“This will enable practice providers and pharmacy management systems to better prepare for the mandatory launch on January 2022 1st,” said, the official health portal site for German pharmacies

The new e-prescription app.
The new e-prescription app. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

READ ALSO: 10 rules to know if you get sick in Germany

There is some leeway though – if there are technical difficulties, paper prescriptions can still be issued in individual cases until the end of June next year.

The National Association of Statutory Health Insurance Physicians estimates that it could take until mid-2022 until all users are equipped with e-prescription applications nationwide.

The obligation does not apply to privately insured people from January next year. Private insurance companies can decide voluntarily to make the preparations for their customers to use the e-prescription.

What’s this about an app?

To be able to receive and redeem prescriptions electronically, people with statutory health insurance need the Gematik ‘das e-Rezept’ app. 

One issue is that the app appears to only be available at the moment in German app stores. We’ll try and find out if there are plans to change this and widen out the access, but it seems likely for that to happen. 

Germany’s Covid-Warn app, for example, was initially only open to German app stores but was gradually widened out to many others. 

As mentioned above though, those who don’t have access to an app will be able to use the paper with the code on it to access their prescriptions. 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

Has it all gone smoothly?

As you might expect, there have been a few hiccups. 

Originally, the introduction nationwide was planned for October but was postponed due to many providers not having all the tech requirements set up. 

Now though, more than 90 percent of the practice management systems have been certified by the Association of Statutory Health Insurance Physicians – a prerequisite to issue the e-prescriptions.

The e-prescription is part of Germany’s far-reaching plans to digitise and streamline the health care system.

The head of Gematik GmbH, Markus Leyck Dieken, recently spoke of a “new era” that is “finally starting for doctors and patients” in Germany. 

Useful vocabulary:

Prescription – (das) Rezept

Doctor’s office/practice – (die) Arztpraxis

To order – bestellen 

Pharmacy – (die) Apotheke

Video consultation – (die) Videosprechstunde