Berlin - With complex mix of proposals, several universities have submitted an expert report on future requirements planning. The study commissioned by the Federal Joint Committee (), which is available to the Deutsches Ärzteblatt, presents on 722 pages various calculations and analyzes of how more precise requirements planning for resident doctors could work in the future.
The central statement is accessibility by resident doctors: In the future, more than 99 percent of the population should be able to contact their family doctor within 15 minutes and specialist within 30 minutes. These specialists include urologists, ophthalmologists, ENT specialists, surgeons, dermatologists, orthopedists, neurologists and psychotherapists.
According to the accessibility analyzes, this can also be achieved, explained the experts working with Leonie Sundmacher from Munich. Pediatricians and gynecologists are an exception. "These two groups of doctors are of particular relevance close to home, as large population groups are less mobile, but they are frequented relatively frequently," the report says.
Longer journeys in the country
In rural regions, however, there are longer journeys. According to the expert opinion, there are "weaknesses in accessibility" in rural areas of Mecklenburg-Western Pomerania and Brandenburg, in the border area of Bavaria, Thuringia and Hesse as well as in the southwestern border area of Lower Saxony and in the west of Rhineland-Palatinate.
Loud According to the analyzes, patients prefer care at their place of residence over their place of work. Especially for specialist doctors, however, the rate of commuters must be taken into account in the calculations, so that co-provision effects from the adjacent planning districts can be included.
Define basic services
In order to be able to better distribute doctors, The summary of the study says that it should be defined “more strongly than before”, “which basic services doctor in group of doctors should cover in basic care”. Quota regulations could help "to take into account different care offers and sub-specializations also in other groups of doctors."
Deutsches Ärzteblatt print
The reviewers plead also for subspecializations among internists - suggestion that G-BA chairman Josef Hecken also made some time ago, but which has so far been rejected by the Federal Ministry of Health.The report suggests that subspecializations should not be carried out on small scale, but rather that “planning at the level of the spatial planning regions for larger specializations of the specialist internists and at the level of the KVs for smaller subjects” should be sought.
Allow discretion
< p> This also means that the reviewers advocate being able to better calculate the care costs of resident doctors. Since “there are no generally applicable guidelines for the coding of diseases, the documenting contract doctor must make decisions within his discretion.” This is so dependent “on habits and experience” and thus also varies regionally.Hence the plea: "To strengthen the data base for calculating needs-based ratios, the experts recommend guidelines that improve the coding quality of outpatient diagnoses." The billing data available so far from the National Association of Statutory Health Insurance Physicians (KBV) as well as data from health insurance companies does not contain any socio-economic information on patients.
Criticism of the lack of comprehensive monitoring
In order to be able to better determine the need for doctors with this data as well, the reviewers recommend similar to the data in the risk structure adjustment “including geo-referenced diagnostic data relating to the patient's place of residence and information on the occupation status of the members for the purpose of demand planning. ”So far, the data from the risk structure compensation has only been used for the financial flows between the individual health insurance funds.
The experts criticize the fact that there is no nationwide“ comprehensive monitoring ”of the use of the instruments the requirements planning there. Apparently there is also no exchange between the regional planners and the actors involved as to which options for requirements planning are useful. Overall, the experts advocate that, in addition to regional characteristics, there should also be “nationwide indicators” “in order to avoid unequal standards in access to care throughout Germany”.
Application for 1.25 seats
In doing so, they also demand that "alternative models or temporary supply contracts" be issued in regions that are experiencing decline in population due to the demographic development and therefore no stable planning can take place. This also includes the “delegation of services and compensation of services between groups of doctors”, as another chapter is entitled. It recommends: "General practitioners should be able to apply for 1.25 seats instead of just one seat in regions with undersupplied or undersupply, if they are supported by at least 0.5 full-time assistants."
The report is part of the current reform phase of requirements planning.As early as 2012, the legislature commissioned the G-BA to take into account the social and morbidity structure in addition to demographic developments when determining the proportions of population and doctors. Actually, resolution should have been made by January 1, 2017. However, this had been delayed - the report presented now is intended to recommend the missing method. So far, the plan is to discuss the results of the report in the G-BA committees by the end of 2018.
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