Modelling future ambulatory care utilisation in Germany: A Microsimulation of patient demand and physician supply

Ensuring accessible and adequate outpatient healthcare close to patients homes is a central concern in Germanys health policy and societal debates. Against the backdrop of demographic change, an ageing medical profession, and changing professional priorities, the shortages in care are intensifying, particularly in rural regions. Concurrently, rising life expectancy is leading to an increase in age-associated, multimorbid conditions that require complex management. These developments affect both the supply of physicians and patient demand.

This work presents a district-level model of future healthcare utilisation and relates it to projected physician supply trends. These demand-side projections build directly upon a previous supply-side microsimulation model, which projected the future number of physicians, their specialities, and working patterns. Methodologically, the study employs a dynamic microsimulation of the entire German population within the MikroSim framework. The model is developed using data from national health surveys, from which sociodemographic and morbidity-related determinants of utilisation behaviour are identified. Considering the systemic differences in access, distinct models are developed for individuals covered by statutory (SHI) and private (PHI) health insurance, with the primary focus on simulating utilisation for the SHI-insured population. The primary outcome measures are the projected annual frequency of physician contacts, differentiated between general practitioner and specialist consultations on a regional district level.

The results, contingent upon improved future data availability and ongoing model refinement, can provide an evidence-based contribution to enhancing regional and sectoral needs-based planning in outpatient medical care.