Remedies
A remedy is a substance, object or treatment process that is supposed to have a beneficial effect on the patient. Until the 19th century, the word remedy was used synonymously with medicine , medicament or medicament; Colloquially, the term is still often used today. In the German social law of the 20th century in particular , however, the meaning of the term has fundamentally changed. A conceptual separation between medicinal products and medicinal products was introduced in Germany with the Reich Insurance Code of 1914.
Remedies in German health insurance law
The legal basis for supplying the health insured with medicinal products is § 32 SGB V. The law does not define what medicinal products are concerned with, but it gives the Federal Joint Committee the mandate to determine more details about the supply of medicinal products in a guideline in accordance with § 92 SGB V.
According to the Therapeutic Products Directive , medicinal products are medical services to be provided personally. In detail, these are measures
- physical therapy
- podiatry therapy
- voice, speech and speech therapy
- the occupational therapy and
- the nutritional therapy
The Therapeutic Products Directive regulates the conditions under which the measures may be prescribed by a doctor. The remedies catalog attached as Part II of the Directive defines the remedies that can be prescribed in detail.
Medicines may only be dispensed by approved service providers at the expense of the health insurance companies. The requirements for admission are regulated by Section 124 of SGB V - Admission. For the nationwide application of the conditions of admission, the legislature has commissioned the umbrella association of health insurance funds to develop admission recommendations and to update them continuously (Section 124 (4) SGB V).
According to the current approval recommendations, the following service providers can be approved for the dispensing of therapeutic products:
→ Physical therapy: masseurs , masseurs and med. Lifeguards, physiotherapists / physiotherapists
→ Voice, speech and language therapy: speech therapists , state-approved speech therapists and other qualified professional groups
→ Occupational therapy : occupational therapists (occupational and work therapists)
→ Podiatry : Podiatrists, state-approved medical podiatrists and other qualified professional groups
→ Nutrition Therapy: dietitians , nutrition scientists , nutritionists and other qualified professionals.
Approval is granted by the state associations of health insurance companies and the substitute insurance companies (Section 124 (5) SGB V).
The ongoing assurance of the proper performance of therapeutic products by the approved service providers is based on the framework recommendations of the umbrella association of health insurance companies and contracts between professional associations of service providers and associations of health insurance companies § 125 SGB V. The framework recommendations regulate and a. the statutory additional payment, supply processes, quality and profitability audits, further training and specifications for remuneration structures. The contracts then specify these requirements for the contractual partner area. As stipulated in Section 124 of Book V of the Social Code, the contract with suitable service providers does not yet establish any specific claims for remuneration. The insured person and not the health insurance company then selects a specific service provider.
Remedies in Austrian law
The Austrian social law determines in paragraph 136 of the General Social Insurance Act that remedies include "the necessary medicines and other means that serve to eliminate or alleviate the disease or to ensure the success of the cure". Medicines are therefore also among the remedies in Austria. A distinction is made between remedies and remedies, which include glasses, orthopedic shoe insoles, hernia and other things.
Remedies in Swiss law
In Switzerland, too, the term therapeutic agent has a significantly different legal meaning than in Germany. There, remedies are a generic term for drugs and medical devices; Both product groups are in the Therapeutic Products Act regulated and which also Swiss Agency for Therapeutic Products mentioned Swissmedic approved and monitored.
Individual evidence
- ↑ Article 1 of the law of December 20, 1988, Federal Law Gazette I p. 2477
- ↑ Guideline of the Federal Joint Committee Guideline on the prescription of therapeutic products in contract medical care (Therapeutic Products Directive / HeilM-RL) in the version of May 19, 2011, published in the Federal Gazette No. 96 (p. 2247) of June 30, 2011 in Entered into force on July 1, 2011, last changed on September 21, 2017, published in the Federal Gazette ( BAnz AT 11/23/2017 B1 ) entered into force on January 1, 2018
- ↑ cf. Section H in "Self-employed in Health Care" by Ernst Boxberg and Frank Rosenthal, medhochzwei Verlag Heidelberg, ISBN 978-3-86216-016-7
- ↑ Section outpatient services
- ^ "The delivery of remedies" by Frank Rosenthal, Asgard Verlag Sankt Augustin, ISBN 3-537-34922-X
- ^ "Handbook for service providers of therapeutic aids and aids" by Frank Rosenthal, Asgard Verlag Sankt Augustin, ISBN 3-537-53799-9
- ↑ See also Dierk Stelzer : Are service contracts to be publicly tendered nationwide within the framework of the service provision law of the statutory health insurance according to "nationally transformed" public procurement law or to be awarded in a "public invitation to tender" or otherwise? - The exclusion problem with regard to the “nationally transformed” public procurement procedure law in the form of the types of procurement for service contracts for therapeutic products in the statutory health insurance, Part 1 . In: Journal for European Social and Labor Law (ZESAR), 2004, pp. 460–470, Part 2: ZESAR, 2005, pp. 21–31.
