Gender Medicine in Germany: What is so Difficult about its Implementation? - An Empirical Study in Germany –


      Personalized medicine is currently a popular topic in health care debates. Yet, the basic differentiation between females and males is hardly found in care delivery / health management programs. This study aimed at elucidating the opinion of German Statutory Health Insurance (SHI) managers and internal specialists regarding gender-specific care in order to understand their perceptions on responsibilities and possible implementation opportunities.


      Between April and June 2013, a questionnaire on the implementation of gender medicine in the current health care landscape was developed. Based on literature review and expert consultations, it included open- and closed-ended questions on expectations/prioritization, need for action, and implementation of gender medicine. Forty-eight insurance managers of the largest German SHIs, covering over 95% of the market, and approximately 16,000 physicians of the German Society for Internal Medicine (DGIM) were contacted to complete a web-based survey. Descriptive analyses, Chi-square tests, and Pearson correlation coefficient were used to investigate the research objective.


      According to both, insurance managers (76%) and physicians (60%), gender-specific care is not sufficiently incorporated into standard medical care. Respondents claim the responsibility lies with the ministry of health, physicians and medical staff, as well as their associations. Specifically, more evidence is needed to incorporate gender aspects in treatment guidelines, an idea which is well-supported by insurances (65%) and physicians (70%). A top-down approach for implementation is preferred by 65% of insurance managers and 50% of physicians, whereas fewer participants encourage bottom-up mechanisms.


      German SHIs expect a significant governmental influence and/or support of self-governing bodies to achieve an incorporation of gender medicine into daily practice. Primary responsibility for the integration of gender-specific approaches is perceived to lie with physicians. As soon as critical hurdles in the medical field will be removed, the positive perception of both participating parties can be integrated in the implementation process of gender-medicine.