2 - From Traditional Individualism to Collective Professionalism: State, Patient, Compulsory Health Insurance, and the Panel Doctor Question in Germany, 1883—1931

Summary

In all industrialized societies, doctors have become exemplary professionals. In different industrial countries, however, the relationship between patients and doctors is arranged differently. In Germany it was Bismarck's social policy and, especially, the advent of health insurance for workers that created the special historical conditions shaping this relationship. As a consequence, in the center of my inquiry lies the rise of compulsory health insurance, as it developed in Germany in the dynamic triangle of the (publicly insured) patient, the panel doctor, and the state between 1871 and 1931. In this chapter I shed light on how doctors first opposed the “collective patient,” as the laborers' Krankenkassen organization was called, and then eventually came to accept this new health care system.

doctors and the state before bismarckian social policy

Doctors and the State before Bismarckian Social Policy / The history of academically trained doctors from the beginning of the nineteenth century to the founding of the German Reich in 1871 is characterized by two developments: the formation of a uniform professional group and their liberation from direct state control. The state was largely responsible for the homogenization of doctors as a group: Training was standardized and controlled; so was the examination, registration, and the supervision of doctors. The role of the state can be seen as marking the historical difference between the professionalization of medicine in Germany and that process in the United Kingdom or the United States.