That could bring the return of the practice fee

The health politicians of CDU/CSU and SPD It was certainly aware that the proposal would cause a fuss. Therefore, the signal word practice fee does not appear in your intermediate paper for the coalition negotiations. Instead, the following, technically sounding sentence can be found: « For a better and targeted care of the patients and for a faster appointment, we introduce a binding primary doctor system in the free choice of doctor through home and pediatricians from HZV and in the collective agreement. » The abbreviation HZV stands for household -centered care. However, the connoisseurs of the health system knew what is hidden behind the civil servant: return to the practice fee. A look back can help to understand the instrument and its effect.

How did the practice fee work?

Between 2004 and 2012, patients had to pay ten euros as a fee per quarter when visiting a doctor’s office – whether at the general practitioner or specialist. If other practices were consulted in the relevant quarter, the ten euros were due again unless a transfer could be submitted. The money also had to be paid for the treatment in a rescue center. Freed from the fee were chronically ill. The exception of two check -ups at the dentist, preventive examinations during pregnancy, cancer early detection and recommended vaccinations.

Has the practice fee fulfilled?

Two studies have examined the effect of the instrument. The Central Institute for Statutory Health Insurance In 2008 analyzed the practice fee. Central result: After the introduction in 2004, doctor’s contacts fell by 2.9 percent compared to the previous year. That sounds little at first, but in the reality of the health system the effect was noticeable. According to the Federal Association of Statutory Health Insurance Physicians, 575 million treatment cases in Germany occur in the practices each year. Of these, three percent less results in about 17 million cases. « The introduction of the practice fee initially had a deterrent to patients, » concluded the study author. But after that, a habituation effect started. « The number of treatment cases increased again during the time of the practice fee. »

According to the investigation by the German Institute for Economic Research (DIW), the number of doctor’s contacts even decreased by the practice fee by 8.8 percent.

How much money did the health insurance companies take?

The annual income amounted to around two billion euros. This is also the amount with which the health politicians from the Union and SPD expect, the 10 euros should be raised again. For comparison: the statutory health insurance companies took 320 billion euros last year. The practice fee is a drop on the hot stone from a monetary point of view. It was hated to find out the ten euros because of the bureaucratic effort at the medical practices.

Why was the fee abolished?

At the turn of the year to 2013, the fee fell after a decision of the Bundestag – without a vote against. « I have never experienced that in the German Bundestag, » commented Parliament Vice President Wolfgang Thierse (SPD). Germany had overcome the difficult years of mass unemployment and survived the world financial crisis quite unscathed. You could do without the income.

What do experts advise?

In 2018, the Council of Experts in the Healthcare Council recommended strengthening the household -centered care in Germany. If this is not enough to improve the tense situation, « should the introduction of a contact fee for specialist visits without transfer. » The Federal Government’s patient representative, Stefan Schwartze (SPD), thinks this is a mistake. « The practice fee has shown in the past that it does not work as a control instrument. It was introduced in 2004 to supposedly reduce unnecessary visits to the doctor, but the hoped -for effect failed to do, » said Schwartze of our editorial team. A renewed practice fee could lead to « that people avoid necessary visits to the doctor for cost reasons, » criticized the SPD politician. Schwartz’s assessment gives an indication that a practice fee is particularly support for CDU and CSU. The Association of Statutory Health Insurance Physicians advocates offering various tariffs with health insurance. If you choose the family doctor model, you would have to pay lower contributions.