A digital shot in the arm for German healthcare

“Yes, I can get you an appointment with the doctor in two days.” Never have these words sounded more endearing than a few weeks ago when I started hunting for a general practitioner in Berlin. After a tiring internet search and countless unpleasant phone enquiries, success was mine. All that was required of me now was to wait patiently.

Waiting time to see a physician has been a contentious topic and can be exceptionally long in Germany – an observation (both personal and empirical) that many will relate with. Often, patients have to wait for weeks before getting to see a doctor. But is the situation any worse than in other European countries? Not necessarily. Can it be made better? – Certainly!

Recently, a move to increase the allocation of hours physicians spend with patients who have statutory health insurance from 20 to 25 per week was deliberated in the upper house of the German parliament. Physicians will of course be monetarily incentivised for such extra effort in different ways. Concurrently, debates around levying a fee on patients for missing appointments are gaining traction – penalising patients for hoarding appointments will likely free up space and capacity constraints on practitioners. However, are sticks for patients and carrots for providers an effective solution to tackle the waiting time monster?

Research evidence from other areas albeit with similar rationale has repeatedly pointed to the contrary. Financial penalties for latecomer parents at day care centres are known to backfire, actually increasing the late collection of children by parents, since they view it as a small price to pay for extra time at the centre (also relieving them of the moral guilt). Similarly, physician incentives in some contexts have led to patient selection and physicians gaming the system. Increasing the number of hours physicians work does not guarantee that the number of patients seen will increase. It might simply lead to more consultation time. Moreover, introducing financial elements to a traditionally altruism-based service does not ring the right bells. There is, therefore, ambiguity to what instituting such penalties and incentives might lead to. It will only be a matter of time before we find out whether these carrots or sticks work as intended.

While we let policymakers debate and researchers figure out whether traditional models of healthcare delivery will work in Germany now and in the future, other systems have already taken steps towards harnessing the power of artificial intelligence and technology to solve the waiting time crisis. While Britain in general, in my opinion, is far from a model to emulate given the current political scenario, its National Health Service has, in the past, certainly served as a best practice example for many health systems in Europe. The English NHS has already rolled out ‘Babylon’, a digital health service with instant symptom checkers designed to handle virtual general practitioner (GP) appointments, prescriptions, and even digital health checks.

In fact, artificial intelligence offers a wide set of opportunities on both the provider and patient’s side – for example, identifying patients who are likely to miss appointments based on prior history and combining this knowledge with subtle nudging techniques to remind such patients of impending visits; ChatBots acting as gatekeepers to screen unnecessary care-seekers and free up doctor capacity; or a more transparent physician-patient appointment system through which patients can quickly select alternative practices with free appointments. Artificial intelligence (AI) can act as a powerful aid to healthcare providers in determining who to see and when, building on patient history and healthcare usage patterns particularly when we know that the demand for healthcare can be volatile.

Optimal waiting time cannot be zero, since it is often used as a rationing device in the face of capacity constraints. But the possibilities with technology and artificial intelligence are endless in rationing more efficiently. Notwithstanding the fact that Germany is considered one of the leading nations in the field of AI, it seems surprising that innovative ways of reducing GP waiting times are not part of mainstream political discussions. Given the new tech-savvy generation and constantly changing external environment, we will need to rethink traditional models of healthcare delivery. Of course, several questions and issues arise with the use of technology in healthcare, but we do not have to make it a ‘man versus machine’ problem, when it really is a ‘man with a machine’ solution.

This op-ed appeared originally in the German daily Der Tagesspiegel (in German).