Health
What does Lauterbach’s family doctor offensive achieve?
Better working conditions should help to maintain the network of GP practices in view of the coming wave of retirements. Photo
© Stephan Jansen/dpa
For patients, family doctors are important nearby contact points and guides through the system every day. But the health network is strained in many places. Can new incentives help?
Better conditions for general practitioners’ practices should ensure more secure on-site care for millions of people across Germany. This is what the Federal Health Minister’s legislative plans are aimed at Karl Lauterbach, who launched the cabinet.
“This makes it easier for patients to get doctor’s appointments, unnecessary visits to the doctor are eliminated, and long waiting times in the doctor’s office are avoided,” said the SPD politician. Financial incentives are planned for this. Doctors’ representatives called for further steps, patient advocates and health insurance companies expressed doubts about improvements.
Lauterbach made it clear that the topic even has significance for democracy. One should not allow “medical banlieues” to develop in the countryside or in poorer parts of large cities – i.e. hotspot areas in which there is no longer sufficient care. There are already 5,000 family doctor seats vacant nationwide. The profession should therefore be made “more lucrative, less bureaucratic and therefore more attractive”. “I think it will work,” said the minister. It should also be attractive that family doctors can work more from home, for example to issue prescriptions or sick notes digitally.
Aging of society also among general practitioners
The offensive for better conditions is intended to maintain the practice network with a view to imminent waves of retirement. Family doctors are the first point of contact for insured people and guides in the system, according to the draft. There has been no further decline recently. According to the Federal Medical Register, there were 51,389 general practitioners at the end of 2023, 75 more than at the end of 2022. However, ten years earlier there were 52,262. Among general practitioners, the proportion of people over 60 is particularly high at 37 percent.
compensation
For general practitioners – as is the case for pediatricians – the usual upper limits on remuneration are to be lifted. This means that they will definitely be paid for extra work, even if the budget is exhausted. “Every service will be paid for,” said Lauterbach. This should also make it more attractive for general practitioners to take on more patients again. The change is likely to result in a “lower three-digit million amount” in additional costs for statutory health insurance companies, as the ministry estimates.
New flat rates
Practices should receive an annual “flat rate” for patients with mild chronic illnesses and little need for care. This is intended to avoid visits to the practice every quarter just to get prescriptions and to create more freedom. General practitioners could medically determine whether someone should come twice or eight times a year, explained Lauterbach. Practices that meet certain criteria should receive a new “reserve fee” – for example for home and nursing home visits or evening consultations after 7 p.m.
Young people
According to the draft, psychotherapeutic services for children and young people are also to be improved. To this end, a new group of doctors is to be formed to plan for demand. This will enable “more precise control of the options for setting up” practices.
transparency
According to the draft, a digital information and comparison service is to be created for those with statutory health and long-term care insurance. Figures on approvals, rejections and objections to certain health insurance benefits will be available there, as well as on processing times and the quality of advice and support services.
MVZ
It should become easier for municipalities to set up medical care centers (MVZ) in which doctors work under one roof – among other things, by easing the amount of security deposits required.
In the waiting line
In order to get the project underway, Lauterbach has removed some points that were controversial within the coalition. However, they will be brought up again in the parliamentary deliberations. These include “health kiosks”, i.e. easily accessible advice centers for treatment and prevention in areas with many socially disadvantaged people. Lauterbach also wants to campaign for an end to homeopathic services at the expense of health insurance companies. The draft is now going to the Bundestag, and the first reading is planned before the summer break.
Reactions
The Association of General Practitioners welcomed “noticeable improvements” through the removal of fee limits. However, this is not enough to turn things around. The umbrella organization of statutory health insurance funds criticized “little added value for a lot of contribution money.” Without the control instrument of remuneration caps, there could even be less incentive to run practices in rural areas. The German Foundation for Patient Protection explained that a decision to do so depends on other factors. And for chronically ill, elderly and people in need of care, it is becoming increasingly difficult to find a new general practitioner after closing a practice. Union expert Tino Sorge (CDU) criticized that it was completely unclear how specialists should also be supported.