Berlin, Frankfort Health Minister Karl Lauterbach (SPD) chose drastic words when he spoke about the entry of private investors into medical practices. “Locusts” are at work there with “absolute greed for profit,” he said recently.
A law planned for the first quarter to prevent the purchase is still pending. But the announcement alone caused widespread criticism among operators, which the Federal Association of Operators of Medical Care Centers (BBMV) and the Association of Accredited Laboratories in Medicine eV (ALM) want to underpin with a new report.
At the initiative of the associations, a trio of experts examined the role played by investors in outpatient care. The report was presented on Wednesday. New regulations, it says, would ultimately even have a negative impact.
The restriction would not lead to a guarantee of supply in rural areas, but to a further aggravation of the already precarious situation in some places,” write the authors.
They include the health economist Frank-Ulrich Fricke and the lawyers Werner Köhler and Stephan Rau. They also expect fewer jobs for doctors and fewer investments in outpatient care.
All signs point to regulation
Instead, the authors consider “quality-oriented competition with the greatest possible number of forms of care, providers and investors” to be necessary. “This expressly includes medical supply centers (MVZ) as well as non-medical, private investors, also for the reason that orientation on returns is a characteristic of all investors in the healthcare sector.”
In politics, however, the signs point to regulation not only at the federal level, but also in the states. The Bavarian Health Minister Klaus Holetschek recently emphasized this.
The CSU politician justified this with “monopoly-like structures” and a rapid increase in the proportion of MVZ groups with equity participation. The German Medical Association recently made a similar statement.
Among other things, the association demands that in future only interdisciplinary MVZ be approved – and no longer those that focus on one area. For this, the protection of existing rights must be lifted. In addition, the market share of an operator should be limited to ten percent and transparency about the owner should be created.
>> Read more: Rebellion against practice investors
In the past year, reports of takeovers of practices by financial investors had accumulated. This called politics into action. The concern behind this is that investor-driven MVZs will crowd out individual practices and that the range of services will concentrate on certain, particularly lucrative offers – such as ophthalmology or radiology.
Plans are met with goodwill by the FDP
At the same time, there are fears that time-consuming treatments, for example for chronically ill patients, would be postponed. The German Medical Association also reports on employed doctors who have to comply with target agreements for treatments that are not oriented towards patient welfare.
In the traffic light coalition, Lauterbach’s plans are met with goodwill even from the FDP. Health policy spokesman Andrew Ullmann recently told the Handelsblatt that operators would have to be subject to “certain guard rails”.
A law planned for the first quarter to prevent the purchase of private medical practices is still pending.
(Photo: dpa)
With the expert opinion, BBMV and ALM want to counter the debate. Both associations represent MVZ with capital investors in the background. The laboratory operators are organized in the ALM, a market in which many financial investors are involved.
>> Read here: Why Germany has far too many clinics – and the emergency rooms are still overcrowded
The largest suppliers in Germany include, for example, the internationally active, listed laboratory groups Sonic Healthcare and Synlab with sales in the billions. Financial investor Cinven still holds 43 percent of the shares in Synlab.
Billion market with practices
The outpatient healthcare market in Germany is huge: more than 213 billion euros were spent in the outpatient sector in 2020, almost 90 billion were spent on medical and dental practices, according to figures from the Federal Statistical Office.
Since 2015, there has been an accelerated increase in MVZ establishments, as shown by data from the National Association of Statutory Health Insurance Physicians (KBV). At that time, the incumbent Federal Health Minister Hermann Gröhe (CDU) made it possible to set up MVZs of the same subject and also to introduce public legal forms. The authors of the report also concede that the proportion of MVZs in outpatient care has risen sharply in the past year.
However, the largest part of outpatient care would continue to be provided by individual practices with a share of 78 percent. So there can be no question of displacement or dominance.
In addition, there are no abnormalities “that indicate that the interests of investors, medical or non-medical, influence medical decisions in MVZ to a greater extent than, for example, in individual practices”.
What the KBV data does not show is the extent to which investor groups were involved in the boom in these MVZs. In principle, MVZ can also be founded by doctors or hospital operators, in which investors are involved. Even the German Medical Association admits that the data is poor.
>> Read here: Monopolies Commission sees no improvement for clinics in the country through the Lauterbach reform
The report states, with reference to figures from 2020, that the growth is evenly distributed between medical and non-medical investors. In addition, the proportion of private, non-medical investors is only up to two percent of all doctor positions in outpatient care. For dentists, the proportion is slightly higher at five percent. Conversely, this means that Lauterbach’s law is only aimed at a tiny part of outpatient care.
Growing interest from investors
The numbers are also known to the Federal Ministry of Health, which referred to them in a legal opinion at the end of last year.
A market analysis by the consulting firm Boston Consulting Group (BCG) shows that private investors are showing increasing interest in outpatient care. Of a total of 572 transactions that BCG analyzed between 2015 and 2020, more than 60 percent of the acquisitions were made in the outpatient area.
Huge market
213
billion euro
were issued in the outpatient area in 2020.
“Investors have made increased use of the opportunities created in 2015 to enter the outpatient market,” says BCG partner Zun-Gon Kim. “They bring the necessary capital with them to expand in specialist areas in which high investments are necessary, but in which comparatively higher profitability can also be achieved.”
>> Read here: This way you get the best possible treatment in the hospital
The rapid growth of the MVZ in recent years is influenced by various factors. On the one hand, many resident doctors have reached retirement age and want to sell their practice. “On the other hand, many young doctors are no longer willing to take the risk and pay 170,000 euros or more to take over a practice,” says the consultant.
Selling to an investor is the solution for the practice owner. Last but not least, more and more graduates, especially female graduates, prefer to work as an employee with fixed and predictable working hours and make a conscious decision to work in an MVZ.
More: More than every second clinic is at risk of being downgraded to a health center