Medical rehabilitation services include, in particular, treatment by doctors , dentists and members of other health professions ( Book IX of the Social Code ) if the multidimensional and interdisciplinary approach of medical rehabilitation is required beyond curative care.
Rehabilitation procedures are also used in veterinary medicine .
Forms of rehabilitation
Medical rehabilitation attempts to alleviate physical or mental health problems that threaten the ability to work with medical measures with the aim of averting a disability pension. or to delay the onset of need for care. As part of the statutory accident insurance benefits, it also serves to treat damage caused by occupational activity (recognized work-related accidents , occupational diseases ). There are also special forms of medical rehabilitation for people who are not yet in employment (e.g. children, young people) or for mothers and fathers (mother / father-child measures, measures for mothers).
A special form of medical rehabilitation is the so-called follow-up rehabilitation (AHB) directly after a hospital stay. Follow-up rehabilitation after operations are very often prescribed so that it is easier to re-establish the ability to work or to delay / avoid the need for care. It is customary that the service providers - including the allowance for civil servants - request that the AHB start within two weeks of discharge from the hospital. Since the health insurances on the other hand require that the treatment has to be approved in writing in order to be financed, this period often turns out to be very tight. The prerequisite for an AHB is the prescription of the attending physician in the previously visited hospital. The detailed written justification must be attached to the application to the service provider or the aid agency. Many hospitals have social workers who are responsible for this organizational processing of the application and approval of the AHB. The patient himself or his relatives can also turn to the social worker with the aim of getting a AHB.
Medical rehabilitation measures take place in rehabilitation clinics (formerly: spa clinics) or outpatient rehabilitation facilities.
Another form of medical rehabilitation is mobile geriatric rehabilitation. This is useful for geriatric patients who z. B. are not suitable for an inpatient or outpatient rehabilitation measure for health reasons. However, it is still not widely available in Germany, although it was introduced in 2015 by the Statutory Health Insurance Care Strengthening Act.
The following books of the Social Security Code (SGB) are the legal basis for rehabilitation :
- SGB III for the Federal Employment Agency , also responsible for SGB II and SGB IX
- SGB V for statutory health insurance ,
- SGB VI for pension insurance,
- SGB VII for accident insurance ,
- SGB VIII for youth welfare,
- SGB IX rehabilitation and participation of disabled people,
- SGB XII for social assistance (integration assistance),
- BVersG for pension administration.
- Federal Employment Agency ,
- statutory pension insurance DRV ,
- statutory health insurance companies ,
- statutory accident insurance,
- Providers of war victims and war victims,
- Public child and youth welfare agency
- Carrier of the social welfare .
A claim to inpatient services for medical rehabilitation according to service provider (statutory pension insurance, health insurance company or on their behalf the medical service of the health insurance companies).SGB V in connection with SGB I exists if medical treatment or outpatient rehabilitation measures are not sufficient to recognize a disease, to cure it, to prevent it from getting worse or to admit disease complaints alleviate. As a result of the GKV-WSG, from April 1, 2007, pursuant to Section 40 (2) SGB V, a discretionary benefit became a mandatory benefit of the statutory health insurance companies. According to Section 40 SGB V, Paragraph 3, Clause 4, inpatient services cannot be provided before four years after such or similar services have been carried out, the costs of which have been borne or subsidized on the basis of public law regulations, unless an early service has ended urgently needed for medical reasons. Another prerequisite is that the inpatient rehabilitation service can be expected to result in treatment success. In this respect, the need for rehabilitation, rehabilitation goal and rehabilitation potential must be given in advance, which are assessed by the
A clear presentation of the different ways to medical rehabilitation with the statutory health or pension insurance can be found on the website of the Arbeitskreis Gesundheit eV
The rehabilitation request
In order to apply for rehabilitation, the patient receives an application form from the respective rehabilitation provider (service provider) - an application form can often also be obtained online (however, it cannot be submitted in full online because the associated medical report cannot yet be digitally signed). According to Book IX of the Social Code, every patient has the right to express a “legitimate wish” with regard to the rehabilitation facility in which they would like to be treated, which cannot be refused without legal grounds. For the area of health insurance it says z. B. in SGB V that the health insurance company determines the type, duration, scope, start and implementation of the services as well as the rehabilitation facility at its discretion according to the medical requirements of the individual case . The applicant should at least ensure that the clinic of their choice has been certified by an independent body and that this certification has been recognized by the Federal Association for Rehabilitation (BAR). This is to ensure that therapy is carried out according to high, regularly checked quality standards. In case of doubt, he should always seek advice in advance from the responsible rehabilitation provider (e.g. the health insurance company or the pension insurance company).
Responsibility of the service providers
In most cases, the statutory pension insurance , statutory health insurance , statutory accident insurance , pension administration, public youth welfare agencies or social welfare agencies ( ) are the responsible service providers for medical rehabilitation. After the application has been received, the service providers will clarify with one another who is responsible. If the service provider first contacted is not responsible, he or she will forward the application to the person responsible within a period of 14 days ( SGB IX). If he does not forward, he is legally responsible. For civil servants, the allowance covers a proportion of the costs of medical rehabilitation; this happens outside of SGB IX. Other service providers can be private health insurance or private accident insurance .
For people of working age, a statutory pension insurance provider is most often responsible in terms of numbers. A pension insurance institution is responsible as soon as the insured person whose performance is at stake has completed the waiting period of 15 years or has made mandatory contributions for six calendar months in the last two years or is already receiving a pension due to reduced earning capacity ( SGB VI - further alternative prerequisites are possible; so-called insurance law prerequisites). Medical rehabilitation benefits can be granted in accordance with Book VI of the Social Code if the insured person's ability to work is seriously endangered or reduced due to illness or physical, mental or emotional disability and if his ability to work is likely to be reduced if his ability to work is seriously endangered The ability to work can be averted through the benefits or, in the case of reduced ability to work, it can be significantly improved or restored through the benefits or the significant deterioration of which can be averted ( (1) SGB VI; so-called personal requirements). The discretion of the pension insurance institution can be reduced to such an extent that a service for medical rehabilitation has to be provided if the insurance law and personal requirements are met.
Medical rehabilitation services are not provided by the pension insurance company before four years after such or similar rehabilitation services have been carried out, the costs of which have been borne or subsidized on the basis of public law regulations. This does not apply if early benefits are urgently required for health reasons ((2) SGB VI).
The statutory pension insurance is usually responsible if a rehabilitation can avert limitations in earning capacity (e.g. avoiding early retirement). This also applies to employees in the passive phase (= release phase) of partial retirement. The principle applies: "Rehabilitation before retirement". For z. B. Employed persons, job seekers or recipients of a pension due to reduced earning capacity, the statutory pension insurance is the right contact. It is also possible that insured persons who are unable to work and whose earning capacity is significantly endangered or reduced according to a medical report, are requested by the health insurance company to apply for medical rehabilitation. In the urgent procedure, medical procedures are approved by the statutory pension insurance even at short notice , so that the right to z. B. Sick pay remains secured for the time being. After an inpatient or full-day outpatient service for medical rehabilitation, rehabilitation aftercare may be considered. Tele-rehab aftercare has been available since 2017 . The service providers are rehabilitation facilities: "Rehabilitation facilities can work with external providers."
The National Health funded rehabilitation services to disability or long-term care ward off, to eliminate, mitigate, compensate or their aggravation to prevent ( para. 2 SGB V). The catchphrase here is: “Rehabilitation before care”. Statutory health insurance provides services for medical rehabilitation, as well as maintenance and other supplementary services ( SGB IX). She is often the point of contact if no other service provider is primarily responsible or if pension benefits are necessary, e.g. B. to prevent an impending disability or need for care. Statutory health insurance is the responsible service provider, especially for children and young people, non-working adults and pensioners. The health insurance company decides on the application using the medical service of the health insurance company . The main criteria for the decision are the rehabilitation guidelines of the Federal Joint Committee of Doctors and Health Insurance Funds and the “Prevention and Rehabilitation” assessment guidelines. In addition, statutory accident insurance, war victims welfare , child and youth welfare or social welfare can be service providers. Without an allocation of benefits, the Nursing Insurance Act also contains the principle: Rehabilitation comes before care.
See also: Medical prescription certificate
After a socio-medical assessment and an examination of the application under insurance law, the person to be treated receives a notification from the service provider and has the opportunity to object to the decision . The service provider determines the type, duration, scope, start and implementation of the rehabilitation. For cost reasons, outpatient and partial inpatient services generally have priority over inpatient rehabilitation. Methodical rehabilitation usually lasts three weeks, if necessary longer. The resulting absences are considered to be unable to work.
For inpatient and outpatient medical rehabilitation, the costs are borne by the service provider. In the case of inpatient rehabilitation and outpatient rehabilitation at the expense of the health insurance company, the person to be treated must make an additional payment of 10 euros per day, which is limited to a maximum of 42 days in the case of follow-up medical treatment under the statutory pension insurance. However, there are ways to be partially or completely exempt from it, e.g. B. with a low income. In addition, co-payments due to a previous hospital stay in the same calendar year are taken into account. No co-payments are due for outpatient rehabilitation, unless the health insurance provider is the service provider ( (5) SGB V). Children up to and including 18 years of age are generally exempt from co-payments. If the statutory pension insurance pays transition allowance during inpatient rehabilitation, the additional payment obligation does not apply for the duration of the transition allowance payment.
Costs, personnel expenses, profitability
The DRV-Bund (Deutsche Rentenversicherung Bund, formerly BfA) employs, according to its “competent own” statements at a rehabilitation conference in Berlin in May 2006, approx. 6000 employees only in the rehabilitation sector. In 2012, 119,312 people worked in preventive and rehabilitation facilities throughout Germany, 90,582 of them full-time. The expenditure for rehabilitation amounted to 2.1% of the total expenditure for the pension insurance in 2008. The expense for disability pensions was 5.9% for the same period.
Scientific studies show that an average medical rehabilitation measure pays for itself by just four months by postponing drawing a disability pension. The DRV-Bund cites comparable figures in its 2013 annual rehabilitation report. The Prognos study Medical Rehabilitation of Employees - Securing Productivity and Growth from 2009 shows that "for every euro invested in medical rehabilitation ... society already wins five euros back today".
The importance of medical rehabilitation is shown in this study through three different scenarios of its economic impact: 1. constant importance (“status quo”), 2. moderate increase (“realistic”) and 3. an “optimistic” variant in which all actively promote the development of those involved in the rehabilitation process. With the rehabilitation-related additional income from the statutory pension insurance alone, the amount of the third scenario would increase to approx. 3,880 million euros in 2025, in contrast to the forecast approx. 950 million euros from the first scenario. Even in the “realistic” scenario, the additional income increases to almost four times the value of the starting year (2005).
The study makes the following recommendations to underpin an economically sensible strengthening of medical rehabilitation:
Recommendations for strengthening
|of acceptance (especially to service providers and providers)||the framework conditions (especially in politics)||networking (between service providers, providers and those affected)|
|according to Prognos study 2009|
Indications for rehabilitation
There are many indications for prescribing a rehabilitation measure or follow-up treatment. Many accidents or illnesses can mean that the patient needs intensive care after the acute care / treatment in the hospital. On the other hand, not every hospital treatment entitles you to a subsequent AHB. The AHB indication catalog of the responsible rehabilitation agency is decisive for this.
Examples of possible AHB indications are:
- Musculoskeletal disorders (→ orthopedic rehabilitation)
- Heart attack (→ cardiac rehabilitation)
- Traumatic brain injury (→ neurological rehabilitation)
- Spinal injuries (→ neurological / sports medical rehabilitation)
- Polytraumata (complex injuries involving several body parts / organ systems)
- Cancer (oncological rehabilitation)
- Mental illnesses such as B. Schizophrenia (psychiatric rehabilitation)
- Psychosomatic illnesses such as B. Eating disorders or somatoform disorders (psychosomatic rehabilitation)
- Hearing impairment (rehabilitation for the hearing impaired)
- Acquired disorders of binocular vision and eye movements , as well as visual acuity - and visual field loss ( Rehabilitation of visual disturbances )
- Speech and swallowing disorders (neurological rehabilitation)
- Addiction ( drug therapy )
Occupational groups in medical rehabilitation
In a rehabilitation clinic, depending on the treatment order , several professional groups work under medical supervision and by order of a doctor in order to be able to restore the social reintegration (and, if possible, also the patient's ability to work). In addition to specialists, doctors and medical psychotherapists, who have usually completed special additional training in social medicine and rehabilitation, these include:
- Labor educators
- Audio therapists (DSB)
- Occupational therapists
- Nutritionists and dietitians
- Health and Healthcare
- Curative educators
- Speech therapists
- Massage therapists and medical lifeguards
- Medical assistant
- Motopaedists / Mototherapists
- Orthopedic technician
- Psychologists who may specialize as neuropsychologists or psychological psychotherapists
- Social workers / social educators
- Sports therapists
Treatments in medical rehabilitation
According to the occupational groups listed above, the therapeutic range of rehabilitation facilities is mostly varied and tailored to the patient's special rehabilitation indication. It ranges from medical treatment to many other methods and the like. a. the physiotherapy , classical massage , nursing treatment, dietary advice, group and individual psychotherapy, denture care and counseling services.
The central element in the context of any medical rehabilitation measure is also the socio-medical performance assessment.
Since this is about an assessment taking into account the performance restrictions resulting from all physical and mental illnesses of a patient and the question of the certificate of work and disability, this may only be carried out by doctors. A performance assessment by other professional groups such as psychological psychotherapists (see restriction of powers in the wikipedia article Psychological psychotherapist ) is therefore not legal.
In-patient medical rehabilitation facilities must have a certified QMS in accordance with Quality assurance has been carried out in the areas of medical rehabilitation since 2000 . Since 2010, the minimum personnel requirements for the area of inpatient rehabilitation facilities that are responsible for the pension insurance have been set. All 1,600 outpatient and inpatient rehabilitation and care facilities in Germany have been participating in the BQS Institute's QS rehabilitation process since 2012 , unless they are participating in an equivalent quality management program of the pension insurance . The BQS Institute for Quality and Patient Safety was commissioned by the National Association of Statutory Health Insurance Funds to carry out an independent quality check. The ICF classification system enables the integration of the contextual background and the individual influencing factors of the person to be rehabilitated as an effect characteristic on the respective health disorder in the proposed therapy and previous diagnosis.(3) SGB IX so that they can be used by social benefit providers. Section 37 of Book IX of the Social Code stipulates that the various QM procedures must be accredited by the Federal Association for Rehabilitation eV (BAR).
- Rehabilitation report 2013, publisher: Deutsche Rentenversicherung online (PDF; 814 kB - last accessed on March 31, 2015)
- REHADAT references
- Federal Association for Rehabilitation e. V. (BAR)
- German Association for Rehabilitation (DVfR)
- German Society for Medical Rehabilitation (DEGEMED)
- Federal Office of Statistics
- § 8 Guidelines of the Federal Joint Committee on Medical Rehabilitation Services (Rehabilitation Guidelines) ( Memento of the original from April 6, 2016 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. according to § 92 Abs. 1 Satz 2 Nr. 8 SGB V in the version of March 16, 2004, published in the Federal Gazette No. 63 (p. 6769) of March 31, 2004
- The new rehabilitation guidelines (Part II). How to prescribe correctly ( Memento of the original from April 6, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. The general practitioner 13/2005, p. 64
- Institute for Rehabilitation Research Norderney (IfR): Rehabilitation research in Norderney. Retrieved November 3, 2015 .
- Arbeitskreis Gesundheit eV: The way to rehabilitation - FAQ (Arbeitskreis Gesundheit eV) . Archived from the original on May 10, 2015. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved April 6, 2015.
- Doctors Zeitung: Rehabilitation for patients in partial retirement remains a matter for the health insurance fund .
- German pension insurance, aftercare, accessed on November 13, 2017 (  ) /
- Requirements of the German pension insurance for tele-rehabilitation aftercare, accessed on July 16, 2018 ( archived copy ( memento of the original of July 16, 2018 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original - and archive link according to the instructions and then remove this note. ) /
- Guideline of the Federal Joint Committee on Medical Rehabilitation Services (Rehabilitation Guideline). (PDF; 59 kB) April 17, 2014, accessed on November 3, 2015 .
- Assessment Guideline Prevention and Rehabilitation. (PDF) (No longer available online.) February 2005, archived from the original on November 23, 2012 ; Retrieved April 14, 2013 .
- Destatis: Basic data of the preventive or rehabilitation facilities online (PDF; 1.57 MB - last accessed on April 6, 2015)
- Rehabilitation report 2010, publisher: Deutsche Rentenversicherung, p. 67 f. online (PDF; 5.6 MB - last accessed on October 28, 2010)
- Schneider M .: The cost-effectiveness of the rehabilitation of heart attack patients. In: Deutsche Rentenversicherung 8–9 / 1989, pp. 487–493
- Rehabilitation Report 2013, Ed .: Deutsche Rentenversicherung, p. 74 f. online (PDF; 814 kB - last accessed on March 31, 2015)
- version of the Prognos study 2009, p. 1 online (PDF; 189 kB - last accessed on March 31, 2015)
- Structural of rehabilitation facilities - requirements of the German pension insurance, publisher: Deutsche Rentenversicherung, status May 2010 ( PDF , last accessed on 25 August 2012)
- Ruthard Stachowske The ICF in Medical Rehabilitation from Dependency Disease.Retrieved May 17, 2014.