Doctors hopping

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Doctors hopping ( sham Anglicism from English hopping = "hopping", in English actually doctor shopping ) is a catchphrase that has been introduced by the health insurance companies . You use it to refer to the use of several doctors from the same specialist group without a referral by a family doctor , which is unnecessary and undesirable from the perspective of the health insurance companies. With psychotherapists it is called therapist shopping.

In the opinion of the health insurers, doctor shopping occurs, for example, if a patient can be treated by several general practitioners or specialists from the same specialist group within a quarter without the doctors involved being aware of it. From their point of view, doctor shopping represents an abuse of the free choice of doctor . If a patient only gets the opinion of a second doctor because of an illness, one generally does not speak of doctor shopping.

Distribution of visits to the doctor

The following section looks at the distribution of the number of patient contacts with a doctor among those insured by statutory health insurance funds in Germany in 2007.

  • 25% see a doctor 1 to 4 times a year.
  • 25% see a doctor 5 to 10 times a year.
  • 25% see a doctor 11 to 22 times a year.
  • The 25% who visit the doctor more than 22 times a year see an average of 40 times a year and make up 60% of all doctor visits.

The number of doctor contacts depends heavily on the state of health. This is why older people go to the doctor much more often than younger people. Women between the ages of 20 and 34 see a doctor about twice as often as men of the same age. From the age of 75, men see a doctor more often than women. 50% of the doctor's visits are made by only 16% of the insured. Since the statistics were created from billing data, people who never visited a doctor during a year are not included.

According to various reports and analyzes, the average number of outpatient doctor visits per year in Germany is 16, 16.3, 17.1 or 18.1. Since the number of visits to the doctor depends on the patient's state of health and the patient's age, the development of the average number of doctor contacts depends on demographic developments. This must be taken into account when comparing different years or countries.

Internationally, the numbers in Germany are high. Only in Japan , Slovakia , the Czech Republic and Hungary are they at a comparable level.

Studies

The health insurance companies are of the opinion that this patient behavior was facilitated by replacing the health insurance vouchers with the health insurance card. A study by the Scientific Institute of the AOK refuted this in 1999. The main results of this study were:

  1. Only a small proportion of the insured saw several doctors with the same specialty in one quarter; abuse was the exception.
  2. The most important reasons for patients for a change of doctor were dissatisfaction with the previous doctor or getting a second opinion.
  3. Only a very small proportion of those insured visited several doctors in order to be prescribed drugs several times .

Data from the 1990s showed that the number of visits to the doctor by the insured did not increase significantly, there was only a shift in favor of specialists, who were visited more frequently without first consulting the family doctor.

The central institute for statutory health insurance of the KBV surveyed doctors in three statutory health insurance associations . Of these, only 7 percent reported individual cases of abuse. The Deutsches Ärzteblatt then spoke of a nationwide "fraud rate" of 0.014% (dpa of November 8, 1995).

General practitioners are most frequently visited in Germany with almost seven contacts a year. There are only similarly high doctor contact rates in Japan or the Czech Republic.

The basis for the following evaluations was data from 1.4 million GEK insured persons in 8.3 million treatment cases and with 27 million ICD diagnosis codes from 2004. 91% of the insured persons had at least one doctor contact. On average, there were 16.3 doctor contacts per citizen. For 2008, the GEK study presented in 2010 showed 18.1 doctor contacts per person with statutory health insurance. This does not include contacts with dentists, company doctors, public medical officers, hospitals and other practitioners such as midwives, alternative practitioners, physical and occupational therapists and private doctors.

Two thirds of the German population see their family doctor at least once a year, on average every inhabitant 6.6 times a year. 10% of the insured have a high contact rate for outpatient services. They account for a third of all doctor contacts and 43% of treatment costs. 1% of the insured cause approx. 13% of the costs.

Most patients tend to be more loyal to their doctor, however. In 2004, 66.3% of the population went to a general practitioner at least once, of which 74.5% only went to one doctor in this specialty, 20.5% two doctors, 4% three doctors and 1% four or more doctors. 25.7% of the population consulted a gynecologist, of these 56.3% only one doctor of this specialty, 36.3% two doctors, 5.8% three doctors and 1.7% four or more.

German primary (house) doctors have an average of 243 patients per week, in other industrialized countries examined in the study mentioned below it is mostly between 102 and 154. The time per patient contact averaged between eleven and 19 minutes internationally, in Germany it was below eight minutes. One of the causes of the widespread dissatisfaction of German general practitioners could be their burden from the higher number of shorter patient contacts.

In 2006, only nine percent of the German population did not see a single resident doctor. The number of outpatient psychotherapeutic treatment has increased by 61% since 2000 to around 730,000 patients in 2006. The figures are based on evaluations of all treatment and diagnosis data from contract doctors for the almost 1.6 million insured persons of the Gmünder Ersatzkasse (GEK), which were extrapolated to the German population as a whole. According to this, in 2006 91% of the population had contact with at least one statutory health insurance doctor or psychotherapist . This does not include visits to the dentist. 48.5% of the population have seen at least four doctors or psychotherapists. An average of 6.8 treatment cases (quarterly billing) and 17.1 doctor contacts (i.e. 2.3 contacts per quarterly billing) were registered per head of the population. That is a top value in international comparison. Compared to 2004, the number of contacts has increased by about five percent according to these calculations.

reasons

The reasons for visiting the doctor can be very different. One cause is a lack of trust in the family doctor or the treating doctor or the medical profession as a whole. Often, doctor hopping is likely to be due to illness, for example in the case of mental illnesses, especially somatoform disorders such as hypochondriac disorder . Doctor hopping also occurs with drug addicts, who visit a large number of doctors to get the medication they need, and with terminally ill people who hope that consulting as many doctors as possible will still have a chance of recovery. One cause of what appears to be doctor shopping can also be misuse of the health insurance card by several people.

The organizational quality of a doctor's office should not be underestimated: after a doctor-patient contact, patients often have questions, e.g. B. regarding the taking of medication or the further procedure. Sometimes individual specialists (e.g. after x-rays or a gastrointestinal / colonoscopy) avoid discussing the findings and refer to the referring colleague.

Due to the number of cases and budgeting of the remuneration per patient, many practices close several weeks a year. Patients have no choice but to seek a representation during this time.

The billing rules for patients with statutory health insurance promote multiple contacts in the quarter through surcharges for a second contact (regulation for chroniclers).

consequences

For private health insurances , with which private patients are insured, doctor shopping leads to additional expenses, because medical services and examinations are carried out multiple times and must be remunerated accordingly. For statutory health insurance companies, doctor shopping does not increase the total remuneration that is paid to contract doctors (formerly: statutory health insurance physicians), because it is budgeted. Doctors hopping there leads to a decline in the point value of the services, in other words: the contract doctor receives less fee per service. In addition, doctor shopping has an impact on drug costs due to the higher number of prescriptions that individual doctors write. But limitation measures also take effect here, because drug costs are also budgeted for patients with statutory insurance.

Hopping around the doctor is not without its dangers for the patient, because, for example, different medications can lead to undesirable interactions, which in turn have to be treated and again lead to unnecessary costs. In the case of underlying mental illnesses, doctor hopping can contribute to the chronicity of the syndrome and provoke incorrect somatic treatment.

On the other hand, by changing doctors, a patient can find a more competent doctor who can treat or cure his illness better. This can also save the health insurance company costs.

Countermeasures

In principle, there are no sanctions in the sense of fines or service limitations against doctor shopping. The introduction of the practice fee could be seen as an attempt by the legislature to limit unnecessary visits to the doctor. Doctors and health insurances can work together to try to analyze the reasons for doctor hopping and to advise their policyholders and patients and to point out alternatives. In order to be able to take such measures, however, the doctor shopping must be known. Clues for the health insurance companies can be, for example, drug data and invoices from the statutory health insurance associations , but the problem is that the health insurers often only have access to this data with considerable delays, making it difficult to intervene in good time.

Specialists are increasingly demanding a referral from the family doctor, even if this is the first doctor's visit in the quarter. As a result, direct access to the specialist is made more difficult for patients with statutory health insurance, as there is always an appointment with the family doctor. Appropriate education and training of doctors can help raise awareness of early diagnosis and referral of somatoform disorders to a psychotherapist .

swell

  1. ↑ a b B. Riens, M. Erhart, S. Mangiapane: Doctor contacts in 2007 - background and analyzes. (PDF; 444 kB) February 15, 2012, accessed on April 12, 2013 .
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  3. ↑ Techniker Krankenkasse , quoted from Technik auf Pump , medbiz 01/07, p. 20 f., Supplement to the Financial Times Deutschland
  4. ↑ 16 doctor visits per year. In: Doctors newspaper . 10/11 November 2006, p. 1.
  5. ↑ a b Quoted after a year without a doctor - inconceivable for 90% of the population - top value: 17 doctor contacts per citizen. In: Medical Tribune. Volume 42, No. 49, December 7, 2007, p. 17.
  6. ↑ a b GEK insured persons in 2010, quoted from "18 times a year to the doctor", SZ, January 20, 2010, p. 15.
  7. ↑ a b Quoted from: Medical Tribune . No. 47, November 24, 2006, p. 27.
  8. ↑ WIdO study: health insurance card does not lead to "doctor hopping". ( Memento of September 30, 2007 in the Internet Archive ), July 9, 1999
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  12. ↑ MMW - update. Med. 148. Vol. 46, 2006, p. 3: Germans go to the doctor particularly often
  13. ↑ Klaus Koch, Ulrich Gehrmann, Peter T. Sawicki: Primary medical care in Germany in an international comparison: Results of a structurally validated doctor survey. German Primary Care in International Comparison: Results of a Survey of Doctors, In: Deutsches Ärzteblatt. 104, issue 38, September 21, 2007, p. A-2584.
  14. ^ S3 guideline somatoform disorder. (PDF) AWMF (archived version), April 20, 2015, accessed on September 24, 2019 .
  15. ↑ Matthias Leschke: Thinking about a new patient sport: doctor hopping. accessed on September 24, 2019.
  16. ↑ a b Doctor-Hopping at flexikon.doccheck.com, accessed on May 14, 2017.
  17. ↑ Raimund Schmid: Every fifth old patient haunts the system. at aerztezeitung.de, accessed on May 14, 2017.
  18. ↑ W. Rief, W. Hiller: Somatization Disorder and Hypochondria . Hogrefe, Göttingen 1998, ISBN 3-8017-1059-9 .
  19. ↑ Basil Wegener: Getting to the Doctor Without Hurdles - Looking for New Approaches to Doctors Hopping. at Krankenkassen.de, accessed on May 14, 2017.