Statutory health insurance supply structure law

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Basic data
Title: Law to improve the supply structures in the statutory health insurance
Short title: Statutory health insurance supply structure law
Abbreviation: GKV-VStG
Type: Federal law
Scope: Federal Republic of Germany
Legal matter: Social law
Issued on: December 22, 2011
Entry into force on: January 1, 2012
Weblink: Text of the GKV-VStG
Please note the note on the applicable legal version.

The Statutory Health Insurance Supply Structure Act is an extensive article law that changed the Fifth Book of the Social Security Code on January 1, 2012 in particular . In view of the demographic development, the different supply situation in metropolitan areas and rural regions and the new possibilities that medical and technical progress will bring with it, the law should guarantee needs-based outpatient and inpatient care for those insured in the statutory health insurance.

content

After the financing of the health insurance funds had been reformed with the GKV Financing Act, in particular through the introduction of a uniform, income-independent additional contribution with social compensation and the law on the reorganization of the pharmaceutical market , the GKV-VStG primarily concerned the provision of medical care through Measures to plan needs and to combat the shortage of doctors .

In the legislative process, a bill announced in autumn 2010 by the then Health Minister Philipp Rösler competed with a 14-point plan presented by the Union parliamentary group of the German Bundestag in March 2011. In the summer of 2011, a professional hearing of associations on the draft bill took place in the Federal Ministry of Health. This was based on the cornerstones that the Union and FDP had agreed on at the beginning of April 2011. This was followed by an expert hearing on October 19, 2011 in the Bundestag Health Committee on the draft law of September 5, 2011.

The GKV-VStG meant a farewell to the principle of cost containment in the health care system and led, in particular with the expansion of outpatient specialist medical care, to further incorrect and oversupply.

The Statutory Health Insurance Supply Strengthening Act followed in summer 2015 .

Impact on psychotherapeutic care

Insured persons in need of treatment

Every second to third German develops a mental illness at some point in their life , which is associated with a considerable reduction in quality of life. In the industrialized nations with high incomes, unipolar depression dominates, followed by dementia and alcohol-related addictions. Mental disorders often occur together or are associated with other illnesses. With comorbidity, the incapacity for work also increases rapidly. As a result, only 42.9% of those affected by a mental illness have contact with the medical system. On average, those affected in Germany wait three months (12.5 weeks) for an initial psychotherapeutic consultation. In 31.5% of cases, patients wait longer than three months.

Supply situation

In principle, it is the responsibility of the statutory health insurance to ensure that an insured person receives the necessary treatment in good time. According to the principle of benefits in kind, this means the treatment of the insured person by a contract psychotherapist ( § 72 SGB ​​V). Health insurance companies also reimburse the costs for self-procured services by licensed psychotherapists without health insurance approval if the health insurance company was unable to provide a service that cannot be postponed on time or has wrongly refused a service and the insured person incurred costs as a result. This is regulated by Section 13 (3) SGB V. Even according to the Statutory Health Insurance Supply Structure Act, reimbursement of costs was often the only way for an insured person to avoid unreasonable waiting times for a therapy place.

Statutory health insurance supply strengthening law

Long waiting times increase the likelihood that mental illness will worsen and become chronic, that patients will have to resort to inpatient treatment even though outpatient psychotherapy would be appropriate or completely forego necessary treatment. With the GKV Supply Strengthening Act of July 2015, GB-A was therefore commissioned to revise the psychotherapy guidelines, among other things. As a result, psychotherapeutic care was restructured on April 1, 2017. Various new services to improve acute psychological crises have been introduced as part of statutory health care, for which the therapists do not need additional approval from their Association of Statutory Health Insurance Physicians (KV).

Web links

Individual evidence

  1. ↑ Law on Sustainable and Socially Balanced Financing of Statutory Health Insurance (GKV Financing Act - GKV-FinG) ( Memento of the original of October 13, 2013 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. of December 22, 2010 (Federal Law Gazette I p. 2309) @1@ 2Template: Webachiv / IABot / www.dkgev.de
  2. ↑ Isabella Zipp: The financial reform of the statutory health insurance - with increased contribution autonomy for more solidarity, competition and sustainability? University of Public Administration and Finance Ludwigsburg 2015, p. 6 f.
  3. ^ Gerhard Bäcker : Chronology of new legal regulations. Health Insurance & Health Care 1998 - 2016 January 2017, p. 17 f.
  4. ↑ " Shaping the offer based on the needs of the patient - 14 suggestions for reforming medical care in Germany" , cf. Statutory health insurance supply law: Union pushes the pace Nordlicht, Official Bulletin of the Association of Statutory Health Insurance Physicians Schleswig-Holstein , March 2011, pp. 4-11
  5. ↑ BR-Drs. 456/11 of August 12, 2011
  6. ^ Draft of a law to improve the supply structures in the statutory health insurance (GKV supply structure law - GKV-VStG) BT-Drs. 17/6906 of September 5, 2011
  7. ^ GKV supply structure law website of the AOK Federal Association , accessed on May 19, 2018
  8. ↑ Supply Structure Act : Reactions are different ( memento of the original from March 4, 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. Ärzteblatt , December 1, 2011 @1@ 2Template: Webachiv / IABot / www.aerzteblatt.de
  9. ↑ 14 positions for 2014. Reform of hospital care from the point of view of the GKV-Spitzenverband GKV-Spitzenverband , September 4, 2013
  10. ↑ F. Schneider, S. Vienna, S. Weber-Papen: Epidemiology and Etiology of Mental Illnesses in: F. Schneider (Ed.): Specialist knowledge psychiatry, psychosomatics and psychotherapy. Springer, Berlin, Heidelberg 2017, pp. 3–10
  11. ↑ Norbert Jachertz: Mental illnesses: high occurrence, low treatment rate Ärzteblatt 2013, p. 61
  12. ↑ BPtK study on waiting times in outpatient psychotherapeutic care. Survey by the State Chamber of Psychotherapists and the BPtK ( Memento of the original from March 10, 2018 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. 2011, p. 4 @1@ 2Template: Webachiv / IABot / www.bptk.de
  13. ↑ Benjamin Martens: "Opportunity for therapists without health insurance - or risk for patients?" - The new supply structure law psycheplus specialist information, March 23, 2012
  14. ↑ Reimbursement of costs is often the only way out for mentally ill people. Unreasonable waiting times even according to the GKV supply structure law ( memento of the original dated May 20, 2018 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. BPtK website , January 9, 2012 @1@ 2Template: Webachiv / IABot / www.bptk.de
  15. ^ Jan Moeck: Innovations in contract psychotherapeutic care, spring conference of the working group on contract doctor law in the DAV , March 31/1. April 2017
  16. ^ Structural reform of psychotherapeutic care - useful information for therapists KBV , June 2017