EU Court Ruling Raises Fears of Surge in Healthcare Spending

Reverberations are spreading all across Europe after the European Court of Justice ruled on Tuesday that the time doctors spend at a hospital should count as working time --even if they are resting.

The ruling in the case, filed by German doctor Norbert Jaeger of Kiel, has created shockwaves in Germany and across the EU as experts consider the effect it may have on healthcare costs and employment across the continent.

Jaeger had complained that his workload was too intense after he was forced to go on call after working several regular hospital shifts in a row. His superior requested that he remain on the grounds of the hospital and was even supplied with a bed, according to a court official. German doctors on call are often required to stay on hospital premises after a day shift, while waiting for the following day shift, which can mean a doctor stays at work for as long as 30 hours.

On-call shifts as full working hours

But the EU court in Luxembourg sided with Jaeger, ruling that "a doctor required to be available at the place determined by his employer cannot be regarded as being at rest." A doctor's night shifts should count as full working hours because of "the appreciably greater constraints" of having to sleep at a hospital, the Court said.

"On-call duty performed in a place determined by the employer constitutes in its totality working time even where the doctor is permitted to rest at his place of work when his services are not required," it said. “The court therefore concludes that national legislation such as German law ... is contrary to" EU rules, it added.

Although the ruling will have the most direct effect on hospitals, it will also apply to anyone whose employer requires that person to be on call in a place designated by the employer. It specifically applies to professions covered by the EU working time directive, which sets a maximum working week of 48 hours.

Legal limit could slide

In the case of doctors, this will mean that even when they are not actively working, their weekly working hours will be progressing on a ‘ticking clock,’ meaning more will reach their limit of hours faster. This will, in theory, mean that more doctors will be needed to fill the gaps when others reach their legal limit.

Experts at the Marburger Bund, a German physicians' association with 75,000 members, has estimated that 15,000 additional doctors would be needed to run Germany's hospitals fully staffed, at an extra cost of at least €1 billion ($1.121 billion).

Ulla Schmidt, Germany's minister of health and social security, said these extra costs had already been widely anticipated and covered by additional budget allocations to the health service, such as the €200 million allotted to hospitals for the end of 2004 and the projected €700 million by 2009. This, she added, would mean that hospitals or patients who pay insurance would not face massively higher costs to cover the expanding workforce. Schmidt also suggested that restructuring at Germany's hospitals could also reduce costs in the wake of the ruling.

Shortfall of doctors

In an intervie with public radio broadcaster WDR, Schmidt sought to assuage fears that Germany was facing a shortage of doctors. “We don’t have 15,000 doctors to hire and we don’t know if we even need them,” she said.

Costs and employment issues aside, many people working in Germany's health care sector in the health sector have welcomed the ruling. Jörg-Dietrich Hoppe, president of the German Medical Association (BÄK) said in an interview with the newsweekly Der Spiegel magazine that the ruling would "increase patient safety and end the exploitation of doctors."

Safety and security a bonus

Günther Jonitz, president of the Berlin doctor's federation, echoed his sentiments on safety, telling the Berlin Online news service: “When a doctor has worked for 24 hours, he has the same reaction as someone with a blood alcohol level of 0.01 percent.” He added that the ruling was a great chance to reform outdated organizational structures in European hospitals.

Wolfgang Clement, Germany’s economics and labor minister, said Germany would strive to legally implement the ruling by January. "The ruling must be implemented as soon as possible," he said.