Overall in health care (HC) the demand for administration and business thinking is growing and thus the time practitioners in small, especially owner-run practices can spend on treating patients, rather than meeting competitive market or business demands and fulfilling administrative requirements, is diminishing 1. Business demands and patient demands are contradicting – whereas from a business perspective there is only limited time per patient and a broad range of high margin treatments should be sold to a high number of patients in a short time, patient focus may require long and intensive analysis to find the respectively suitable treatment that eventually only has a comparably low margin. Thus, there is a certain conflict of interest. Some first attempts of voluntary entrepreneurial training for medical practitioners can be seen in Berlin 2. But the importance placed on business training in the education for medical professionals in Germany still is neglectable 3. Other health professionals such as physiotherapists or speech therapists are also primarily trained for high quality medical treatment 4 and suffer from the same training deficiency: business education is missing.
Overall, the competition in HC is growing 5. The opening of potential new practices is not limited by admission constraints anymore 6. The market is seen as turbulent and particularly dynamic, requiring highly flexible business processes 7. Therefore, the need of business thinking and economic treatment optimisation is growing overall. Uwe Reinhard is frequently cited 8 for his comment referring to Alfred E. Neuman’s Cosmic Law Of Health Care stating that: „Every dollar of health spending = Someone else’s dollar of health care income, including fraud, waste and abuse.“ 9
Currently there are only very limited research studies, let alone academic publications, which look at business thinking in medical management not from a hospital perspective, but from the viewpoint of owner-run practices with a limited number of up to 15 members of
1 S. Kock, 2012, p. 113; Schreiber, 2015
2 Freie Universität Berlin, 2018
3 Behringer et al., 2018, p. 253
4 Geiß & Raich, 2018, p. 135; Guse, 2018, p. 136
5 H Börkircher & Cox, 2004, p. 24
6 Schreiber, 2015, p. 15
7 Pütz et al., 2018, p. 39
8 e.g.: Currie et al., 2019
9 Reinhardt, 2009, p. 4
staff. This research makes a first attempt to closing this gap, however does not explicitly limit its research to this practice size. Nevertheless, let it be both in the interviews and the survey, 95% of all research subjects fall into this category. Given the scope of the study, it was decided to limit the research for better result validation to a single field of medical practice, being oral health care (OHC). Further, the study’s scope does not allow to look at all medical systems in Europe, let alone worldwide. For practical reasons it was decided to limit the study to primarily Germany and make some first over-regional validation attempts with interviews, conducted with a limited number of professionals in Hungary. Main focus, however, is Germany, the comparison to and with Hungary was primarily a first attempt to understand if business comprehension and its limitations are limited geographically to Germany, the German system and / or the local culture, or if the limited business thinking is rather linked to the medical profession as such. Due to language and funding barriers it was not possible to pursue the study objectives to the same extent in Hungary as achieved in Germany.
Figure 1: Objectives of the research
The study met a range of objectives as visualized in Figure 1 (also in Appendix A). First, the field was looked at via understanding the stakeholders in HC and by analysing existing publications which were primarily of business nature such as management guides. Second the HC systems in Germany and Hungary, including their historical background, were introduced.
Then quantitative numbers in the field of HC and where possible also OHC, were investigated
•Understand the stakeholders in HC and investigate existing publications on business thinking in HC and OHC.
Objective 1:
•Introduction of HC systems in Germany and Hungary.
Objective 2:
•Secondary data analysis of HC and OHC in Germany and Hungary.
Objective 3:
•Primary qualitative pre-test research to understand the current extent of business thinking in the market today and develop a quantiative questionnaire.
Objective 4:
•Primary quantitative research with surveys to draw conclusions about the extent of business thinking in the market and its impacts on the quantifiable success of OH practices today.
Objective 5:
•Primary qualitative post-test research with a limited number of German practitioners to understand some paradox results.
Objective 6:
•Develop solutions to fill the practitioners business knowledge gap and make a first test of these solutions in a focus group.
Objective 7:
as much for Germany as for Hungary. After having done so, fourth objective was interviewing practitioners in the two countries that run own clinics and to talk to clinic staff and market specialists – also in focus groups. Aim here was to fully understand the business requirements – or better said the business knowledge gap practitioners face and to develop a survey that would contain the best questions for understanding. As a sixth step, some of the resulting paradoxes that were either very different in survey and interview or just seemed contradicting to expectations, were tested in a last round of interviews. Out of the above, the research developed a range of potential solutions to the mentioned problem, alias knowledge gap, as much for university studies, active practitioners aiming to pursue a successful career with an own practice, consultants working in the field and the providers of additional teaching programs aiming to train practitioners and their teams that were discussed in a focus group.