General practitioner-centered care: a model with potential for improvement?

Abstract

General practitioner (GP)-centered care was introduced into outpatient care on the basis of the GKV Modernisation Acts (GKV, gesetzliche Krankenversicherung: German statutory health insurance) of 2004 and 2007. These are predominantly selective contracts according to §73b of the German Social Code (Sozialgesetzbuch, SGB) V, which are signed between management companies such as the German GP Contract Association (Hausärztliche Vertragsgemeinschaft, HÄVG ) and the health insurance funds. The latter are obliged to enter into contracts, while participation by contracted physicians and patients is voluntary. The contract landscape of the AOK and the MEDI association in Baden-Württemberg, Germany, is considered a lighthouse project nationwide: here, approximately 5,300 general practitioners and 3,000 specialists participate in general practitioner (GP)-centered care, and about 1.7 million patients are enrolled. In addition to the higher remuneration for medical services, advantages include better control and continuity of care, the avoidance of misallocations, and the strengthening of the GP as a health guide. The increased administrative burden for participating practices and, on closer analysis, the predominantly economic focus of the contract contents, as well as the fact that they are exclusive to general practices, have proven to be disadvantages. Doing business on the basis of selective contracts leads to a division of the entire medical profession, and medical freelancing is at stake. In order to strengthen primary care in the long term, the collective-contract situation must be expanded and improved through special add-on contracts. At the same time, the risk of morbidity must not be unilaterally passed on to the medical profession through budgeting. A forward-thinking and transparently designed primary care can only be ensured with the full participation of internists in close cooperation with specialists.