General practitioners: Outpatient care: Questionable innovations

General practitioners: Outpatient care: Questionable innovations


Doctors do not necessarily have to check blood pressure in chronically ill patients.

Photo: dpa/Frank Molter

The hospital reform with various draft laws and the debates about them has taken up a lot of space in health policy in the last few months or years. Although the effects of the reform also affect outpatient care, as is now foreseeable, no concrete legal reforms were identified for this area. This will change with a third version of the draft bill of the GVSG. Behind the abbreviation is the uninformative Health Care Strengthening Act.

The bill now brings a bouquet of small-scale measures, some of which have been called for for a long time and some of which have been violently condemned. The planned primary care centers, in which family doctors work with non-medical specialists, including nursing staff, represent a new construction. The centers should cooperate with specialists, but also with physiotherapists and midwives – right through to appointment service points. One of the requirements for such a center is that there must be a cooperation agreement with a health kiosk – which means that the jack-of-all-trades will not compete with doctors’ practices on a large scale.

Because that Health kiosks, of which Minister Karl Lauterbach (SPD) had repeatedly announced at least 1,000, will be significantly reduced, at least in quantitative terms: in 2025 there will only be 30, and then around 220 by 2028. The kiosks have also been heavily criticized for a long time, especially by practicing doctors: They would also need specialist staff, for example medical assistants, who would then be missing from doctors’ practices. The draft law now suggests innovative strength with the possible use of buses for mobile advice in disadvantaged neighborhoods and regions. Costs per kiosk are estimated to be between 400,000 and 660,000 euros per year. 74.5 percent of these should be borne by the statutory health insurance (GKV), 5.5 percent by private insurers and 20 percent by the municipalities. The latter also have the “right of initiative”.

Another innovation would be health regions, which have had some nationwide predecessors for years. To this end, municipalities conclude contracts with health insurance companies and the costs should be shared equally. Such a region offers new opportunities for municipalities to set up medical care centers (MVZ) themselves. Basically, the evolved structures should not only be taken into account, but also included, and at the same time supply deficits should be compensated for.

In addition to such new structures with benefits that are difficult to foresee, the draft law brings a lot for general practitioners. In the future, you can operate without any budget limits. There is also a flat rate for chronically ill people who are constantly prescribed medication. Until now, such a flat rate has been paid once a quarter – the new flat rate should be higher and only be billed once a year. Nursing home and home visits should be paid extra. Besides, there is still an extra retention fee planned, but for this purpose, evening and Saturday consultation hours must be offered regularly, for example.

In addition, the recourse rules for practices are being relaxed: performance audits are only due for amounts of 300 euros or more. This would eliminate a large part of the previous individual checks by health insurance companies, which could cost the GKV three million euros more annually. This brings us to the most sensitive point in connection with this law: the high overall costs incurred by statutory health insurance funds. Various associations have already complained about this in unison, also because there is to be a new funding pot for more medical study places, which is to be filled with two-thirds of the remaining GKV liquidity reserve.

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