Primary medical care in former East Germany: the frosty winds of change.

In October 1990 East and West Germany were reunited. Economic pressures, civil unrest, and the decision of the leadership of the USSR not to back further repression brought down the East German government. With Soviet consent reunification became possible. This seemed the best of all worlds for stability in central Europe and freedom and prosperity for the East Germans. However, the path to such bliss turned out to be thornier than many imagined. East Germany had to accept that virtually all legal, administrative, and political structures would be changed according to the West German model. Unemployment, short time working, and migration to the western part (especially of skilled workers) are some of the problems plaguing the five new federal states. Restructuring the health service might not have been considered the biggest problem under these circumstances, but the structure of eastern Germany's health service differed greatly from its western counterpart. Some of its elements were considered positive by trade unions and social democrats in western Germany and by most in the east. Changes would immediately affect large numbers of people. Time for preparation and negotiation was very short between the opening of borders in 1989 and the final decision to reunite the countries in 1990. The health service and its restructuring were more controversial than many other equally fundamental changes.