Cash registers for restructuring of psychotherapy

Health insurance companies plan reform of psychotherapy

12/12/2013

Psychotherapy is increasingly in demand in times of increasing mental health problems. The Central Association of Health Insurance Funds (GKV-Spitzenverband) has now presented a proposal for the restructuring of psychotherapeutic care in Germany, with the previous weaknesses in the treatment of needy patients should be resolved.

Although have „Germany on an unprecedentedly dense, differentiated and high-quality system for psychotherapeutic care“, but the supply is so far „not everywhere as it would be desirable“, reported the GKV-Spitzenverband in its current press release. For example, in some regions significantly more psychotherapists are active than are actually needed, while at the same time psychotherapists are absent in other regions. In addition, the choice of the therapy direction is often determined by coincidences, such as the free therapy space, rather than by a technically sound selection. To remedy the weaknesses, the GKV-Spitzenverband has adopted a reform paper with concrete proposals for solutions.

Short-term therapies should be promoted
The Deputy Chairman of the GKV-Spitzenverband, Johann-Magnus v. Stackelberg, stressed that „Reduction of bureaucracy, orientation consultation for patients and an end to the short-term therapy permit make care better and shorten waiting times“ should. For example, according to the GKV-Spitzenverband, the binding to very narrow application and approval steps is characteristic of the previous structure of the offer of outpatient psychotherapy. Different contingents of treatment hours would be requested and - if necessary after examination by an expert - approved by the health insurance companies. Here, the GKV-Spitzenverband advocates renouncing the application and approval procedure in this segment in future in order to create incentives for the provision of so-called short-term therapies (treatment based on 22 therapy sessions). These could then take the insured persons on their health insurance card like other benefits, the association reports. For therapists, the planned exemption from the reporting obligation for short-term therapy would be a significant relief.

Orientation Consultation before the start of treatment
However, according to the GKV-Spitzenverband, the promotion of short-term therapy should by no means be at the expense of long-term therapy. These are still available to patients in full as needed. At any time from the Probatorik (Erstbehandlungssitzung) directly into the individual long-term therapy, such as a psychoanalysis, be transferred and then - according to expert opinion - in the hitherto possible hours of up to 300 therapy hours. Changes to the rules and previous practice for the approval and implementation of long-term therapies are not planned, according to the statement of the GKV-Spitzenverband. In order to remedy the often rather random selection of a therapeutic direction, according to the demands of the GKV-Spitzenverband, an orienting consultation will take place in the run-up to treatment. So it could be examined whether a behavioral therapy, a depth psychology treatment, a psychoanalysis or something completely different is the right way. As part of the consultation, the patients should be informed primarily about the different forms of therapy. However, they also serve the therapist for assessment, „whether more inpatient or drug treatment is indicated or whether a self-help group would be better suited“, reports the GKV-Spitzenverband.

In order to improve the chances of success of psychotherapy, the central association of the statutory health insurance plans provides for the introduction of a so-called reflection phase. This inserted after the twelfth therapy session six-week break, open the patient „the possibility of a review of the meaningfulness of the solution of psychotherapeutic treatment“, so the position of the association. It makes sense to such a reflection of the previous therapy, as described by many psychotherapists „Psychotherapy quite essential as the patient's dealing with himself and his situation between sessions“ take place. In addition, the analysis of data from the health insurance companies has shown that often after an initial phase with a high frequency of meetings, the frequency of seeking a psychotherapist abates or the therapy may possibly already be successfully completed. „The six-week waiting period between the two phases of therapy is a brief period of pause and reflection by the therapist as well as the patient as to whether the chosen path is really the right one“, explained Johann-Magnus v. Stackelberg.

Expansion of outpatient group psychotherapy
The GKV-Spitzenverband also addresses group psychotherapy in its reform proposals and calls for an expansion of outpatient structures. So far, only two to three percent of all outpatient therapies are group therapies, while in inpatient settings the groups are the standard. The GKV-Spitzenverband wants to significantly improve the range of group psychotherapy in the outpatient sector in order to: „group-typical impact factors“ to benefit from the therapy and to be able to help more insured persons in a shorter time. (Fp)