Building momentum for healthcare innovation in Germany

The German healthcare system is well-established, effective, and enjoys high levels of trust among the general public. But could these strengths be holding it back from genuine improvement and transformation? Professor Volker Amelung of the Hannover Medical School explores the German healthcare system’s hidden obstacles, and plots a route ahead for healthtech innovation in the country.
Healthcare innovation in Germany

It’s fascinating when you think about it: medicine as an academic field is incredibly innovative, but as a profession it’s very resistant to change. We still run hospitals the way we have for hundreds of years, but the procedures that happen inside those buildings are completely unrecognizable. There is a resistance to change in the German healthcare system in particular, and it’s imperative that we take proactive steps in building momentum towards a better healthcare system for all Germans.

Populations around the western world are aging, and Germany is no exception. According to its Federal Statistical Office, there will be nearly 10 million people in Germany aged 80 or over in 2050, compared to 4.4 million in 2013. Even within an efficient and well-resourced healthcare system, innovation and digitization will be the key to long-term sustainability and dealing with this kind of change. Developments in diagnosis and imaging, connected care and patient data management promise to help maintain and even raise the already high standards of the German system, as well as ensuring the population continues to enjoy broad access to the care it needs.

Winning hearts and minds

Countries like Estonia are often cited as a model for healthcare digitization, but it’s one that’s incredibly difficult for Germany to follow. Estonia was an early adopter of digitization, and due to the country’s size and lack of advanced infrastructure at the time, it was able to ‘leapfrog’ other countries and quickly adopt digital technology in all parts of society, including healthcare. Germany, with its long-established healthcare system, is a far more complex proposition that means digitization is inherently more difficult and costly.

However, while systemic complexity is certainly an issue, it is often overplayed by those seeking to explain why Germany has been slower to adopt healthcare technology innovations. The attitudes and interests of healthcare professionals (HCPs) are often a big brake on progress, and need to be more of a focus.

We need to shift the terms of the argument, presenting new technologies like EHRs to healthcare professionals as vital tools that they need by default to practice their profession

For example, everyone you talk to at the C-suite, academic or policy level will agree electronic health records (EHRs) are a great idea, but when you talk to HCPs at the front lines, the picture is different. From a general practitioner’s perspective, EHRs can sound like more responsibility, more administration, and more time taken away from working with patients. These are of course misconceptions, but the responsibility is on the government, technology providers and payers to prove the value of these technologies.

We need to shift the terms of the argument, presenting new technologies like EHRs to healthcare professionals as vital tools that they need by default to practice their profession, much like how those working in business see Microsoft Office as a key part of their professional lives.

An excess of short-termism?

Germany’s long-established way of providing healthcare has created an environment that many people are comfortable with. Patients have trust in the system, and insurers and HCPs find it easy to stay afloat financially. Against this backdrop, it’s easy to think that the everything is working just fine, but in fact no-one is incentivized to take a more long-term view.

None of the traditional players have anything to gain by changing the system. Consumers don’t change insurer or general practitioner frequently, and there is a widespread view that no matter what doctor or hospital you visit, the standard of service you receive will be the same. As a result, there is little financial or popular pressure on governments, insurers or HCPs to consider a more competition-friendly view.

But we do need to take that long-term view into account: as the median age of the German population edges upwards, it’s a question of when, not if, the demographic pressures become too much for the current system to bear.

There is cause for optimism, though. The healthcare technology sector itself is very strong in Germany and AI is a big topic at the moment. People are talking about how it can change the way doctors work, and there are lots of different pilot projects going on to test these new technologies and ensure we keep learning. What we need now is to capitalize on this early progress and move beyond piecemeal innovation towards something more planned and wide-ranging.

In Germany, the technology is there, the finance is there, but what is lacking is the real drive that says ‘we want to have a different kind of healthcare system.’

Education: the key to changing the technology debate

Broadly speaking, there are three things needed to change a healthcare system: technology, finance and the right attitude. In Germany, the technology is there, the finance is there, but what is lacking is the real drive that says “we want to have a different kind of healthcare system.”

In a way, the shortage of HCPs faced by Germany – and by many other European countries – will help drive uptake of health technology. With fewer doctors doing more work, we will have additional incentives to look more seriously at how technology can lighten the load. In Germany, finding more money is much easier than finding more nurses, for example.

Building this motivation will take years, and has to start with education. I teach at the Hannover Medical School, and our attitude is the more technology the better. It is our aim to train nurses, doctors and pharmacists to be comfortable with technology throughout the healthcare system, wherever there is primary care. Nurturing this attitude within the workforce will take years, even decades, but in the absence of a major shock to the system, this ‘bottom up’ approach is the best route for Germany to a more dynamic and innovative healthcare sector.


Prof. Volker Amelung

About the author

Prof. Volker Amelung

Professor Volker Amelung is professor at the Medical University of Hannover with a focus on health management and international health services research, a post he has held since 2001. He also has lectureships at the Medical University and Economy University of Vienna, Columbia University (NY, USA), and other institutions in Europe. Since 2007, Professor Amelung has also been the president of the German Managed Care Association (BMC) in Berlin. The BMC is a leading independent healthcare association, elaborating innovative concepts in healthcare management and policy. In 2011 he founded the private institute for applied health research (inav) in Berlin.


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