The German government plans a law to tackle illegal deals between doctors and pharmaceutical companies. Anti-corruption groups say the law doesn't go far enough, but doctors' associations hardly consider it necessary.
Corrupt doctors, pharmacists, physiotherapists and care workers could face up to five years in jail if found guilty of bribery, according to a new law being introduced by the German government. On Wednesday, Chancellor Angela Merkel's Cabinet signed off on the anti-corruption plan presented by Justice Minister Heiko Maas.
"Corruption in the health system undermines the trust of patients in the integrity of decisions made by medical professionals," Maas said. "Corruption limits competition and makes medical services more expensive."
Some would say the law is long overdue - it comes in response to a ruling made three years ago by the Federal Court of Justice (BGH) in a case that caused no small outrage. Germany's highest court overturned a conviction for a pharmaceutical firm representative who had written out checks of about 18,000 euros ($20,000) to doctors. These payments were part of the company's incentive scheme, which awarded bonuses to doctors for prescribing certain drugs. This, the BGH ruled, did not count as corruption. The new law is specifically designed to tighten the controls on the cooperation between pharmaceutical companies and doctors.
The power of the pen
"Doctors write prescriptions worth 100 billion euros a year," said Wolfgang Wodarg, head of the health services anti-corruption working group at Transparency International Germany and a doctor himself. "So they have the power to decide with their pens what happens to public money, both taxes and that of public health insurers. And, if they are influenced by people who want that money - that is if they are corrupted - then it creates huge damage, not just financial but also for the patients, who are prescribed things they don't need."
For that reason, Wodarg welcomes the new bill. "Just the fact that corruption has finally become an offense in the health service is important," he told DW. "It seems that the government is taking it seriously."
But is the new measure anything more than a sop after the reaction to the BGH ruling? Roland Stahl, spokesman for the National Association of Statutory Health Insurance Physicians (KBV), is skeptical about it. "I don't know if we really needed a law this urgently," he said. "It's here now, and we basically welcome it. Corruption is a side issue - I'm not saying it's not important, but it's not like there is overflowing corruption in the health system."
Stahl insists that patient-doctor trust is very strong in Germany and any doctor would be a fool to endanger it. Uwe Broch, head of the legal department of Germany's Association of Research-Based Pharmaceutical Companies, makes a similar point. His association has a code that all member companies have to sign up to. "It's very clear that the trust of the patient in doctors' decisions is essential," he told DW. "The fact that independence has to be preserved, especially with cooperations with doctors, is obvious for our member companies. That's what they have been practicing for years, based on self-regulation."
When this draft of the law was first proposed earlier this year, Wodarg and Transparency International wrote a list of amendments in an attempt to strengthen it - almost none of which were taken up.
"What I regret very much is that it wasn't made into a criminal offense liable to public prosecution," Wodarg said. "That means that prosecutors will only investigate if a legally recognized organization presses charges. And that is not good, of course, because this kind of corruption is in the public interest. The prosecutors should be allowed to investigate on their own volition, and that really weakens the law."
Stahl had no time for this argument. "With all due respect, this is something that marks out our justice system - the fact the prosecutors only become active when there is a concrete suspicion," he said. "I'm not a lawyer, but I think it would be bad if state prosecutors just did what they wanted."
Broch also pointed out how vital cooperation between doctors and pharmaceutical companies is. "Without this cooperation, there would be no medical progress," he said. "But of course a tension does emerge in the course of this cooperation - and the doctor's independence has to be preserved in any case."
No one knows exactly how much money is lost through corruption by German health professionals - though most estimates have put the figure at several billion euros a year. The new law - designed to clamp down on that - is likely to come into effect in 2016.