Bill shorter waiting for the specialist

Cash patients should not wait more than four weeks for a specialist appointment in the future

17/12/2014

The question of whether one is privately or legally covered by health insurance has recently become increasingly the focus of politics. In tests, it was found that insured persons usually have to wait much longer for a specialist appointment than private patients, up to 24 days. The Grand Coalition in Berlin now wants to counteract this with the draft of the pension strengthening law passed today.

In the future, patients who have a referral to a specialist should be given an appointment with a specialist at a service center of the Kassenärztliche Vereinigung within four weeks. If this does not work, they should alternatively be examined in an outpatient clinic and treated. Thus, the insured should be helped, without the doctors to take responsibility. At the same time, the associations of statutory health insurance physicians are to set up service centers in the role of the medical representatives in which the appointments are then communicated to the patients.

Critics fear additional costs and overtime
As expected, there is strong criticism of the design. "As a result, the appointment service centers will cost the doctors above all money and time," says Thomas Kriedel, board member of the Association of Statutory Health Insurance Physicians Westphalia-Lippe (KVWL). And he substantiates his statement using the example of Westfalen-Lippe, where around 1.7 million specialist referrals are issued each quarter. "Even if only ten percent of this has to be arranged via a service center, we incur additional staff costs of more than 3.6 million euros," he calculates.

He sees a big problem in the documentation of the „medical urgency“ of transfers. Just like the obligation to notify about the free capacities of medical specialists, they would mean a considerable additional effort for the medical profession. He estimates that in Westphalia-Lippe alone, about 70,000 hours of additional work are incurred as a result of setting up the system of service points.

Free choice of doctor not possible
Criticism also comes from the consumer side. In principle, the Consumer Center welcomes cross-fund coordination of specialist appointments. "But the patients have to be satisfied with the doctor who is offered to them," explains Christiane Grote of the Verbraucherzentrale NRW. There is no entitlement to a specific specialist. This is exactly where the criticism of consumer advocates comes in: "Many patients, however, have a special bond of trust with doctors they know," explains Grote. Although the use of the service points is not compulsory, patients can still try on their own to get an appointment with a specialist in their confidence. But those who really need the appointment quickly can not be picky. Whether or not the law flops also depends heavily on how the implementation looks in detail. So, for example, imagine the question of how far a mediated specialist is from the patient and according to which criteria the „medical urgency“ should be determined. "Otherwise, there is a risk that the appointment service points become paper tigers," says Grote.

Minister of Health Gröhe, on the other hand, had a different view, as expected. He spoke in connection with the pension strengthening law of „best possible care“. „This also means that we ensure a timely placement of a specialist appointment via appointment service points for the legally insured“, said Gröhe in a statement released today on the bill. He did not comment on the criticism of the bill, which had been smoldering for weeks, in his speech on the adoption of the bill. Also on the concrete implementation, he made no detailed information. So you can stay excited. (Jp)