Primary care physician
Family doctors ( HzV ) describes a form of health care in Germany, in which a general practitioner as the first point of contact for the patient coordinates all treatment steps. He thus assumes the role of a pilot or lock keeper ( gatekeeper ). Health services research thus combines two objectives: First, the patient should be better supplied, on the other hand can be saved by coordinating total money.
The statutory health insurance in Germany are obliged to offer their policyholders a HzV. Some funds have signed contracts with physician groups and allow their policyholders to participate in GP models or general practitioner programs. The Insured must for at least one year to go with health problems always first to his family doctor. Exceptions are mostly emergencies, visits to the gynecologist, the eyes and pediatrician, as well as diseases outside the geographical area of activity of the family doctor.
The doctor takes over the treatment, referrals to other specialists or hospitals when needed and ideally has a comprehensive overview of the medical history of the patient and the treatments made. The "gatekeeper function" ( gatekeeping ) to avoid multiple checks and treatment, avoidable drug interactions, interpretation errors isolated working specialists as well as unnecessary visits to other doctors and unnecessary hospital admissions.
Before the introduction of the health insurance card had the medical card each until the family doctor be consulted, which optionally exhibited referrals to a specialist. The introduction of the smart card leading to increased medical bills and thereby higher costs. The idea of the GP-centered care is therefore not new.
Legal
The family doctors is laid down in § 73b SGB V. This requires health insurance companies to offer coverage GP models until 30 June 2009. However, this is still not until November 2009 for all funds and all regions of the case. Also, the GP models of different health insurance companies may differ in the conditions. The § 73b SGB V requires that the quality assurance within the GP-centered beyond supply contracts for the supply laws generally applicable under the collective agreement provisions of the Federal coat contracts. Whether this is respected in practice, has not been proven.
The § 73b SGB V indicates further that the participation for both insured as well as for physicians is voluntary. Consequently, do not automatically assume all GPs participated in these models.
A controversial provision of § 73b SGB V can be found in Section 4: " For the area-wide Guarantee the provision referred to in paragraph 1 have health insurance to include, alone or in cooperation with other health insurance no later than 30 June 2009 contracts with communities that at least half of the participating primary care general practitioners of the district of physicians' association represented. Can not agree, the Parties, the Community may 4a request the initiation of an arbitration proceeding pursuant to paragraph. " This means that organizations that meet the said rate of 50 per cent of the general practitioners who attend primary care, health insurance at the end of contracts can force (appointed arbitrator ) with them by invoking the so-called arbitration courts. In addition to general practitioners also take part in primary care internists and pediatricians at primary care, get no such special status granted in SGB V their associations. Sometimes in the existing models to be the physicians' associations or various medical organizations contractors. Currently, The House Medical Association tries to nationwide own contracts. Cash resist this obligation because they partly fear of the significant additional costs.
Advantages of the GP model
The health insurance can provide the insured one or more advantages, such as reduced co-payments in the pharmacies or lower health insurance premiums. The relation to domestic and family doctor will be strengthened. The doctor knows the patient for years, some for decades. The " Medical tourism" is reduced. The fact that simple treatment cases remain with the family doctor ( not every banal colds must be treated by an otolaryngologist ), the specialists can focus on more serious diseases of their territory. Participation willing GPs can by health insurance to participate in specific - will be required training along with the actual training - also paid.
Disadvantages of the GP model
Opponents of the GP model to see the right to free choice of doctors is limited. In addition, the possibility is difficult to obtain comparative studies and differentiated treatment recommendations ( " second opinion " ) at various medical specialists. In addition, it can be dangerous for years or decades to trust a single doctor. Some GP contracts limit the therapeutic freedom of doctors by requiring the observance of influenced by the health insurance treatment guidelines.
Some critics also doubt that the skills of primary care physicians is adequate for such a complex task. If unable to attend all general practitioners, is the patient who wants to participate in the program, forced to change the family doctor. The participation of doctors can be expected with an increased administrative burden.
If someone other than the selected GP visited or you can go without a referral to a specialist, can entail additional costs.
Investigations
The Bertelsmann Foundation surveyed 2004-2007 9000 citizens and excludes the answers that the GP models have so far not brought the desired effect. The patient did not feel better supplied than usual, and the specialist physician visits even declined to take. Only 59 percent of participants reported an improvement in their health status, but non-participants gave this to 68 percent. Apparently, there's no better by the models, but rather a worse pilot function of the family doctor. The AQUA - Institute for Applied Quality Improvement and Research in Health Care published in early 2008 a study on the behavior of private plans insured in GP models and found that the proportion of specialist visits by GP model participants with referral between 2005 and 2006 remained the same, while it decreased in the control group.
GP models in the countries
Baden-Wurttemberg
In Baden- Württemberg, the first contract for GP-centered care between the house Medical Association, the Medicare composite and the AOK was completed in May 2008. In this contract, which was extended in late 2010 by AOK in response to the changes in the law of the Federal Government until 31 December 2015, are more than 3,600 physicians and 935,000 insured enrolled (as of 10/2009).
The contract includes a number of qualitative factors which improve the care of the participating policyholders, among other things, qualifying and training obligations for the participating doctors, mandatory online connection to electronic billing and regular update of the drug module, introduction of specific, home medical treatment guidelines, rational pharmacotherapy and special services (eg evening hours for working professionals ). For enrolled patients copayment waived if you get medication prescribed for the AOK has entered into a rebate contract. The agreement covers the medical remuneration completely independent of the Uniform Value Scale (EBM ) of the KV system with packages and a few individual services, as well as quality-based additional compensation. It is thus a "full supply contract" (as opposed to " add-on " contracts, which only a relatively small additional fee include the fee payments of Statutory Health Insurance Physicians ).
By the end of 2010 in Baden- Württemberg between the two medical associations and has been virtually completed all health insurance contracts for GP-centered care, partly as voluntary statements ( with the IKK Classic, the technician health insurance and many company health insurance ), and partly in arbitration by the former judge at the Federal Social Court Klaus Engelmann ( inter alia with the other spare and company health insurance ).
Bavaria
In Bavaria announced up to individual health insurance company health insurance all in December 2010 the GP contract.
Background was collectively to waive the statutory medical approval, the recommendation of the Bavarian Hausärzteverband to the GPs. The Bavarian Haus Medical Association sought to supply contracts that no longer move under the Social Code. However, the GPs decided in the vote on the collective system exit majority against a return of the security scheme.
After the exit system had failed, the chairman of the Bavarian Hausärzteverband Dr. Hoppe Thaller resigned from his post. Previously Bavarian Health Minister Markus Söder Hoppe Thaller had demanded resignation. The BHÄV need a " substantive and fresh start " and " unloaded interlocutor ".
Since early 2012, again offer the insurance companies in Bavaria to its insured to participate in the GP -centered care ( HzV ) to. Most GP contracts, however, did not come about through a contractual agreement between the respective health insurance and the Bavarian Medical Association House, but were determined by an independent arbitrator by arbitration ( pursuant to § 73b para 4a SGB V).