What is acute medical care

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Care in rural areas

Promotion of the establishment of doctors in structurally weak areas

In contrast to cities and metropolitan areas, medical care in rural and structurally weak regions is a major challenge in many places. In some undersupplied areas, structural funds from the Association of Statutory Health Insurance Physicians (KVen) have provided incentives for doctors to establish themselves, for example in the form of grants that oblige you to work later as a resident doctor in a certain area. There was also help with setting up a practice and taking over a practice, as well as remuneration incentives for services that were particularly worthy of support, for example home visits in rooms a long way away. With the Appointments Service and Supply Act (TSVG), which came into force in May 2019, the structural funds of the KVen were made more binding, the volume of fund funds increased and the purpose of use made more flexible. This means that the structural funds are mandatory for all KVs. In addition, the KVs have to ensure that the funds made available for funding measures are exhausted. In addition, the possible uses have been expanded, including investment costs when taking over practices, promoting the establishment of in-house facilities and local health centers for basic medical care, and promoting special-needs approvals. In order for doctors to work where they are needed for good care, the law already provided in the past that a practice in an over-supplied area can only be filled if this makes sense for patient care . The decision on a case-by-case basis is made by doctors and health insurers in the admissions committees on site. In rural or structurally weak areas, any existing admission bans for the establishment of doctors can now be lifted, provided this is so determined by the federal states.

Strengthening medical and psychotherapeutic care

With the Health Care Strengthening Act, further training was promoted more strongly in 2015 and the number of at least further training positions in general medicine to be funded increased from 5,000 to 7,500. The advanced training of primary care specialists has been strengthened with up to 1,000 positions to be funded. Further trainees in outpatient care also receive the same remuneration as assistant doctors in the hospital. In addition, doctors have been relieved by the fact that they can delegate certain medical services to qualified non-medical staff, such as practice assistants. It has been made easier for hospitals to provide outpatient medical care if the needs cannot be met by doctors in private practice. In addition, municipalities were given the opportunity to set up medical care centers (MVZ) and thus actively improve care in the region.

With the TSVG, the further training of the basic care specialists has been improved once again. The number of jobs to be funded nationwide was increased from 1,000 to up to 2,000. In addition, the promotion of further training for pediatricians was expressly specified. In addition, within the framework of a further legislative procedure, it was explicitly regulated that at least 250 paediatricians should be funded.

In order to strengthen psychotherapeutic care, the Federal Joint Committee (G-BA) adopted regulations in its psychotherapy guideline with effect from April 2017 to make the range of therapies more flexible, in particular to set up psychotherapeutic consultation hours, to promote group therapies and to simplify the application process. and appraisal procedure. Psychotherapeutic consultation hours, for example, are now anchored in the care as a low-threshold access and acute treatment as an important service. The appointment service points of the Association of Statutory Health Insurance Physicians are obliged to arrange appointments for an initial consultation in such a psychotherapeutic consultation hour and for the promptly required treatments resulting from the clarification. In addition, the powers of psychotherapists to prescribe certain services have been expanded. This applies, for example, to prescribing services for psychotherapeutic rehabilitation, prescribing patient transport, hospital treatment and sociotherapy. In addition, as a result of the Nursing Staff Strengthening Act, psychotherapists can offer video consultation hours.

Ensuring care by midwives

Ensuring a nationwide supply of midwifery help, including the free choice of place of birth, is an important concern of the Federal Ministry of Health. Therefore, various measures have been taken. In the course of the Supply Strengthening Act, the right of recourse by health and long-term care funds against freelance midwives was restricted. In this way, the insurance premiums can be stabilized in the long term. This stimulates the insurance market and ensures a comprehensive supply of midwifery help. Freelance midwives who provide obstetrics and meet certain quality requirements are entitled to a security surcharge that relieves them of the financial burden of insurance premiums.

To support families looking for a freelance midwife, the National Association of Statutory Health Insurance Funds provides an electronic search directory on its website due to a legal obligation in the TSVG. With the aid of access to a comprehensive database, it is possible to search for midwives who work in the vicinity of the insured.

The Prevention Act, which came into force on July 25, 2015, stipulates that the period of midwifery assistance for postpartum care is guaranteed four weeks longer than before, i.e. for twelve weeks. The care can also be extended by a doctor's order.

Measures for digital progress in medical treatments

Telemedical applications, such as video consultation hours and teleconsults (the professional exchange between doctors via video), were introduced into care as early as 2017 as a result of the e-Health Act and through two further legislative procedures (Nursing Staff Strengthening Act and Digital Care Act ) further developed. For example, as a result of the loosening of professional law, telemedical applications in contract medical care have also been declared permissible under drug advertising law for cases in which there is no personal doctor-patient contact in the practice, but instead the exchange takes place exclusively via video. But telemedicine can also make a contribution to safeguarding care in rural areas for patients who are already receiving treatment from the doctor they know, because they can help the patient, but Spatial boundaries must also be overcome for the doctor.

Digitization has to be thought through from beginning to end. In addition to measures to strengthen telemedicine, the statutory right to an electronic patient record was created and measures to enable the use of electronic prescriptions and prescriptions, the so-called e-prescription, were introduced.

Strengthening patient rights

So that insured persons do not have to wait weeks for an appointment with a specialist, the associations of statutory health insurance physicians are obliged to operate so-called appointment service centers (TSS). Since January 1, 2020, they can be reached by telephone on the nationwide uniform telephone number 116117, 24 hours a day, seven days a week. In addition, the KVen also offer digital services (for example at www.116117.de). If a referral is available (no referral is required for arranging a treatment appointment with a family doctor, pediatrician, ophthalmologist or gynecologist), the TSS should make an appointment with a resident specialist within a reasonable distance or, if that is not possible, with a resident specialist is to arrange a specialist examination or hospital treatment. As a rule, the waiting time for the treatment appointment must not exceed four weeks. However, this does not apply to postponable routine examinations and in cases of minor illnesses and other comparable cases. In these cases, the four-week period does not apply. Rather, in these cases the TSS has to arrange a treatment appointment within a period appropriate to the specific treatment requirement. In acute cases, the TSS have to mediate immediate medical care at the medically required level of care (this can in particular be an open doctor's practice, an on-call practice or the emergency department of a hospital). Finally, the TSS should also support patients with statutory health insurance in the search for a family doctor or pediatrician who can take care of them on a permanent basis.

The Care Strengthening Act also stipulates that in future patients will be entitled to a so-called structured second opinion procedure at the expense of the health insurance companies. This entitlement includes an independent second medical opinion for certain predictable operations for which there may be uncertainty as to whether they are medically imperative and cannot be avoided. The Federal Joint Committee (G-BA) determines which interventions the right to a second opinion will apply to. So far, the G-BA has decided on four interventions that require a second opinion procedure: tonsil surgery, hysterectomy, arthroscopy of the shoulder and knee replacement. The G-BA has also stipulated which qualitative requirements apply to the second opinion and which requirements are placed on doctors who are allowed to provide a second opinion. This includes, among other things, many years of specialist medical activity in a specialist area relevant to the procedure. The aim of the legal regulation is to ensure a particularly high-quality provision of the second opinion so that patients can make an informed decision for or against the intervention on this basis. The National Association of Statutory Health Insurance Physicians also provides information on its website with a doctor search portal about doctors who provide an independent second opinion.

Regardless of this new procedure, some health insurances have been offering their insured persons their own second opinion procedures for various serious illnesses for a long time and will continue to assume the corresponding costs as statutory benefits. The respective health insurance company provides information on the requirements.

Further structured treatment programs (Disease Management Programs - DMP) are being developed for the chronically ill. As part of the Health Care Strengthening Act, the G-BA was commissioned to define further chronic diseases for which structured treatment programs are to be developed.

The increase in multiple illnesses and chronic illnesses in our aging society also means a challenge for the further development of medical care. For this reason, an innovation fund with a funding volume of 300 million euros annually was created in the years 2016 to 2019 to promote innovative, in particular cross-sectoral forms of care and for health care research. Due to the law for better care through digitization and innovation (digital supply law - DVG), the innovation fund will be continued until the end of 2024 with an annual funding volume of 200 million euros. This allows targeted projects to be funded that break new ground in care.

In addition, insured persons are now entitled to sickness benefit from the day on which the doctor determines that they are unable to work - and not from the following day. This closes a supply gap for insured persons who are regularly only unable to work for one working day because of the same illness (for example because of chemotherapy or a certain form of dialysis).

For adults with intellectual disabilities or severe multiple disabilities, treatment centers can be set up that are tailored to their needs. People with disabilities and those in need of care with a degree of care according to Section 15 SGB XI are entitled to dental preventive services. In addition to regular visits to the dentist, for example in the care facility, you are entitled to dental prophylaxis services and individual advice on oral and prosthetic care.

In order to ensure that the insured receive seamless care, hospitals are allowed to take on more outpatient services through the Care Strengthening Act. Hospital discharge management is also being improved: on the transition from the clinic to the resident doctor, hospital doctors are now allowed to prescribe drugs, bandages, remedies and aids, home nursing and sociotherapy for a transition period of up to seven days as well Certificate of incapacity for work. As a result of the DVG, teleconsultations, i.e. the professional exchange between doctors in connection with the treatment of a patient, should not only be possible among physicians in private practice, but also between the contracted doctor's practice and the hospital.