The Virtue of Aristocracy Abides No Borders

10 min read

Even within the German Healthcare System

”Quality is not an act; it is a habit”- like Aristotle, the Greek philosopher indicated in 322 BC. Yet today, we still stand struggling to exercise that simple excerpt even though it may seem utterly straightforward. Nonetheless, to infer the quality of an element or service, we must first define it in terms of metrics system, as it cannot be something abstract. Despite all the efforts to ascertain some form of a valid quality criterion, and execute it as the precursor of the value, we eventually identify strong predilection as what are the actual determinants of a given class of mentioned determinants. Healthcare is one big scapegoat of such downfalls. Many would erroneously counteract the universal third party healthcare coverage to the quality of medical service, while others despise the services they receive if not in cord with that of their personal longing. Based on that understanding, the software as a service (SAAS) providers (internet-based business referral services) have created the business model based on the concept of consumer satisfaction portals. Healthcare has been somewhat implicated by such a business fad. For instance, Germany, with the long track record of premium healthcare delivery system in the European continent, and provider of universal health coverage, nevertheless possesses its own particular challenges. The online Patient satisfaction survey is just another fraction of sweeping feats towards executing merit-based service delivery and compensation measure.

In a recent report by DW, a German dermatologist succeeded legal battle to remove a lousy rating report from a website owned by Jameda; a social business referral directory. Over the last decades, public business reviews on sites have become extremely trendy, as millennials more and more rely on testimonies and ratings lent by others to assess the integrity of service providers, hence in this case, the doctor. Although public comments and survey sites are primarily evolved to stimulate the quality of services the public relies on, like discouraging errors, nonetheless, it is far from reliable, especially with the medical profession domain. Because- medicine is the ambiguous science of variability, and identifying those variables is a hard, yet an essential task.

The 21st-century healthcare crisis is not exclusive to the United States, It is a problem encompassing blunder of conveying individual expectations. Under urgency within the spectrum of the allotted social issues, the latter may stand less conspicuous for the economically challenged. For example, for those who are striving financially to make ends meet, any form of primary health care would be deemed a plus; nevertheless, that does not mean equal to better quality. Healthcare topic corresponds to an elephant in the darkroom, as the most contemporary strategies designed to tackle healthcare dilemmas are that one offering a solution by merely glancing at a single piece of the entire picture while languishing to concentrate on the basics or – ”the big picture”.

In the legal battle, Germany’s Federal Court of Justice (BGH) ruled in favor of the physician, asserting that the Jameda website had ceased to sustain the fundamental impartiality. It also argued that Social media unethically, hence illegally, offers discriminatory privileges to doctor’s use paid advertisements on their webpages, meaning they are given web pages that are exempt from links to competitors.

While the world’s policymakers are struggling to maximize patient satisfaction and quality care utilizing information technology and social media parallel to their ongoing efforts, yet the system is flunking them on every ground. That includes patient dissatisfaction to physician Demise. The population health model is fading to function in the face of growing public expectations. To overcome the said obstacle, a value-based reimbursement model has been introduced to motivate physicians and healthcare providers alike through financial incentives driven by patients’ satisfaction and optimal outcome. Under that protocol, health comes to be more of equity where hygiene is a part of human wealth, as it is depicted by the Grossman economic model. Owing to its essence, health can also be considered both as investment interest and consumer welfare, even though it was not meant to head in that direction, to begin with! The main reason for such misconception is because- merely all common mishaps and challenges in the conventional healthcare system originate from the meandering healthcare and health. Along the path of time, technologies prevail innovatively, but lag to deliver what was vowed to deliver. This has served the unhappy aftermath of the physician passiveness steering too many misfit remedies offered to their practices by tech industry that, in turn, led to their disappointment and skepticism. The downtrend has built 21st-century version slavery by signifying corporate elements ever-rising goals, and millennial over-reliance on inadequately validated technologies on one hand and delinquency of the medical community to fulfill those expectations on another has ultimately ushered to the concept of medical nihilism among patients.

The medical nihilism is characterized as a Dis-confirming cognitive disposition to medicine as the sentiment of having nominal confidence in the officiousness of medical interventions, the hypothesis that contends the compelling opinion of faulty modern medicine.

Nihilism is a vital facet that patients possess, that potentially undermines their relationship with the treating physician. One would logically imagine the sophisticated interrelationship between declining components of a medical service delivery model would ultimately decipher into a Quality measure that is also shattered. To clearly understand, first, we must concede that the existence of adequate Quality metrics is a must, thus enabling physicians to delineate patient provisions into measurable objectives. It is also essential to cultivate a set of quality metrics while contriving what exactly needs to be accomplished. Quality metrics are utilized by both commodities and procedures to organize relevant performance standards, somewhat crucial for quality association and altitudes. Stemming of Quality measures by transparency and accountability is the determinant of the valid value of the lent service or a product.

Jameda is not the only tech firm that conforms to all the criteria and failures described. The downfall of establishing net-neutrality is widespread to a preponderance of prevailing industries that are industrious monetizing on public information, sure by those that claim to voyages having to do with service quality reviews and consumer satisfaction surveys. Because over time; social media are typically intimidated into staying ahead of the competition, while their tactical mission is replaced by strategic pivotal role to sustain economic growth. Henceforth, that is precisely what has transpired with the Jameda.

The scheme has already conceded that the time for restoration of personalized healthcare has arrived. For the same reason, the healthcare legislation has been trying to implement a value-based reimbursement service that includes publicly displayed patient satisfaction questionnaires. But the fundamental criticism is directed towards its failure to efficiently factor in the personal determinants of the quality. The current system is still banking on fictitiously driven social determinants based on statistical proceeds. Therefore, the hybrid version of population health utilizing partial patient engagement is the ground for the precipitated clash of expectations with obsolete protocols and procedures.

The problem of failing a merit-based service delivery model is Universal to every industry, as it globally affects the healthcare system. The credible design of feedback and reviews reflecting the quality of service without full transparency is ludicrous. Double standard and hypocrisy in the prevailing business-driven sphere are detrimental.

Software service industry failures to endure Internet net neutrality are a significant concern that is still unappreciated by the public mainstream. There aren’t enough limits to the existing giant powers of internet service providers to undue control of their users. Tech companies can favor, block, or slow specific websites or services. They can freely collect new fees from apps and websites to reach users. Service providers can exempt apps from the user’s monthly data cap if the process oversees to hurting small businesses and the competing startups, something that Jameda perpetrated with the German dermatologist.

Expectation, opportunity, dependence, and abuse make up some of the terms describing a few justifications of why there is discord in modern healthcare. By taking the latter phrases out of the vocabulary, we could effortlessly gain access to universally available healthcare.

Business directories like jameda, yelp, and Angie’s list are frequently leaned upon, but the validation of fairness may be a subject of controversy. Therefore as a pattern of defensive undertaking by the medical communities, unsurprisingly is to observe some form of favoritism towards allotted patients amid ensuring a decent review. Another report published in DW.COM states that German doctors often refuse to accept state insurance plans towards the end of each fiscal quarter in a try to conserve money. However, just like the trend we see in the United States, Germany’s profit-driven health care system is also being castigated, as State health insurance carriers continue fighting to visit their doctors towards the end of every quarter. In contrast, according to the study, privately insured patients get easy access. Latest seems to come as a surprise to the German citizens who take advantage of the country’s universal health care system. That indeed is not surprising to their US counterparts. The politicians in Germany recognize that as systems downfall is simply because their policies incentivize profit over health. it is imperative to uphold that Excessive reliance on online reviews will stem in favoritism by influencing the neutrality of services rendered, thus incentivize prejudice. As we can see from the DW report, Universal healthcare is not an oddity anymore, even in the country with a reasonably well-assembled system, like Germany. Researchers found at the Hamburg Center for Health Economics (HCHE), about physician’s quarterly pattern showing slowdown of the patient clinic visits during the last weeks of every quarter. The study observes the habit as a sign of fiscal restraint that typically comes with the government-run system. According to researchers, Germany’s state health insurance companies would only authorize reimbursement of the full rate of particular treatments up to a given number of patients or a limited financial value. This limit functions as a sort of allowance for such treatments, which make up 50 to 90 percent of popular treatment, depending on the expertise. Once a particular physician’s limit has been consumed for that extended quarter, the doctor puts the brakes on or flat shut down the practice until the onset of the new quarter. The trend is especially popular amongst the general practitioners (US counterparts of Primary care physicians), and dermatologists, ophthalmologists, and gynecologists. In contrast to private third-party payer insured subjects continued to receive treatment during that juncture. In the confirmation, according to DW, countries on Green political party health spokeswoman, Maria Klein-Schmeink said in an interview that German doctors have unduly ample incentive to deliver remedies that make the most dough. According to her, the actual health windfalls are not the focus, as she believes in restoring the system towards a fairer dispersion of resources that rewards good care for the patients. I strongly believe that kleins rhetoric howl just as familiar as the one we heed in our system in the United States about healthcare reform and the Affordable Care Act (ACA). In the report, Dr. Johannes Schenkel, medical director of Germany’s independent patients’ advice center (UPD), uttered– the research completed by the HCHE has precipitated substantial criticisms of his office. As a result, it is utterly obvious now, not only patients are striving to get entry to the healthcare system, but they also have issues obtaining an appointment as well as finding the right doctor. It is completely stunning to receive a report of this nature. The HCHE has underlined the findings of the study as a solution to the healthcare problem, not being straight forward. Simply lifting regulations that encourage restricted treatments, as some have suggested, could lead to healthcare cost ripple effect. Following its report, HCHE admitted; it seems like the nation’s healthcare is at dreadlocks, as there will be very little space for any reform in Germany’s health care system any time soon. Today German citizens are a long way into the “citizens’ insurance” plan that was formerly advocated by the countries Social Democratic Party (SPD). The plan was initially introduced under the premise that it would effectively end the inequality between state and private health insurance, yet not the budget system itself. Within the turmoil of meeting patients’ demands, expectations, and appropriation of quality and valuable medical service, the obstruction of Internet Freedom and Healthcare Rights by the tech industry and the corporate cartel is clattering the foundation of medical practice. While to it, yet the governments are still blaming physicians for the blunders of policymakers. By capitalizing on the software algorithms, the tech industry has shattered the concept of Net neutrality. The medical industry has the privilege around the previously defined principle that internet service providers have to grant access to all websites and content and must not block certain websites, sources or practice favoritism  otherwise, physicians may likely be compelled to adapt to the system by trying to avoid pitfalls, cut overhead and alternatively maximize revenue stream. This need not come as a surprise when Germany’s government is doing exactly the same, only in this case, by way of creating a cap on quarterly reimbursements.

As trivial and controversial as it may sound, every governmental administration is no more than an organization, just like any other business entity. Therefore, irrespective of the constitutional structure they live by, citizens will ultimately suffer the consequences of the decisions made by administrations. Healthcare has evolved into an accepted political principle, but politics haven’t unraveled the fundamental dilemmas with any healthcare system in the world.

The core problem

The substance of the healthcare problem lies within the perception scope of what real quality and value entailed by a given system. Without proper description, there seems to be always something missing within the recommended remedies. For those residents, particularly in the United States, National Healthcare Controversies exists like the notion of the Grass being Greener on the Other Side of the Fence, wrongfully speculating that having government-run single-payer system is the ultimate antidote.

One can convey many justifications as to why healthcare coverage for all does not mean quality healthcare for everyone, or universal healthcare; not being inevitably Affordable to all, or why it is restricted in the scope of coverage and availability.

Compared to Germany; in the United States and most other developed countries, the notion of national health plan is practically nonexistent; but all share identical challenges. In the European continent, the dominant populist movement is the driver of rare tolerance of people to one size fits all solution. Still, the Jameda legal conflict represents the epitome of changing climate among people of Germany and the world. There seems to be no middle ground when it comes to healthcare and patient expectations. There is neither a budgetary explanation of administrative mandate that can satisfy communities’ rationales.

Healthcare is personal; between one patient and one physician. Populist oratory under the population health model lacks gear to satisfy individual wants, be it patient or the doctor. It sure neither a corporate-driven remedy exists to of the same. Unlike what illustrated by politicians, healthcare is not a purely economic issue, although it has been inappropriate politicized as such!

Healthcare will always be about more options and better quality in the eyes of the beholder. The value of a service inferred based on individual subjective perception, the profile of objective social determinants in the face of limited physician resources, is deceitful. The notion of”the customer is always right” would not necessarily apply in today’s healthcare outlines, since the logistics of accommodating a favorable environment for patients interact with their doctors is absent. This is even lacking in the face of depicting the most helpful reviews. The current system is compelling doctors to snatch a guarding perspective and hold a behavior of keeping the patient and the system appeased. Admittedly, German physicians like their U.S. counterparts are struggling to find the realistic path out of dual dogma.


The problem with most modern approaches to the understanding healthcare crisis is it’s an inclination to peek at the individual slabs of the puzzle without sufficient appreciation of the big picture.

To establish personalized care and value-based reimbursement criterion, we ought to change the public mindset by generating cognition of individuality. Change stands to be the Ultimate Solution for Physicians’ frustration.

Over period; physicians have conformed to certain habits that serve as a comfort zone in their everyday practice domain. But today, patterns don’t help them well. The transition in medicine; and patient expectations demand medical community’s adjustment to how they perform. On the contrary, what we witness today, the corporations should be the ones carrying the burden of support on behalf of physician interests without compromising their independence. Therefore, entities must move towards increasing transparency and honoring the value of patient-doctor relationships.

We should empower patients by way of engaging them to make their own healthcare decisions with infusion and backing from their doctors. Patients should also take part in the development of physician achievement criteria that are pertinent to themselves- consistently and transparently. We have been fixated on outdated policies that have been failing our communities over and over again. The new generation needs a modern, intuitive, and unique reasoning. Autonomy and empowerment are fundamental to the millennial temperament.

Once again- Honoring Individual choice, physician autonomy is essential. Remember, everyone can be misinterpreted. That is even true for patients, but keeping them happy at the toll of physician autonomy exclusively breathes profitable to corporate acquisitiveness.

Adam Tabriz, MD Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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