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Integrated primary care in Germany: the road ahead.

Schlette S, Lisac M, Blum K - Int J Integr Care (2009)

Bottom Line: Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult.Recent policy reforms improved framework conditions for new forms of care.Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

View Article: PubMed Central - PubMed

Affiliation: Bertelsmann Stiftung, Carl-Bertelsmann-Str. 256, 33311 Gütersloh, Germany.

ABSTRACT

Problem statement: Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult.

Description of policy development: Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and 'community medicine nurses'.

Conclusion and discussion: Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

No MeSH data available.


Medical care centres—growing numbers.
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fg002: Medical care centres—growing numbers.

Mentions: With medical care centres the lawmaker gave physicians in ambulatory care and hospitals the option of a new form of cooperation that allows for a shared use of resources. Although the law does not include mandatory participation of primary care providers, many medical care centres offer primary care services. Since 2004, more than 1000 medical care centres have been set up (see Figure 2 Medical care centres—growing numbers), with ca. 4800 staff physicians—compared to the total of 130,000 doctors who work in ambulatory care in Germany. Among them are about 793 general practitioners and 488 internists—making primary care physicians the largest specialty group working in this type of health care delivery system [32, p.3, 7].


Integrated primary care in Germany: the road ahead.

Schlette S, Lisac M, Blum K - Int J Integr Care (2009)

Medical care centres—growing numbers.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2691944&req=5

fg002: Medical care centres—growing numbers.
Mentions: With medical care centres the lawmaker gave physicians in ambulatory care and hospitals the option of a new form of cooperation that allows for a shared use of resources. Although the law does not include mandatory participation of primary care providers, many medical care centres offer primary care services. Since 2004, more than 1000 medical care centres have been set up (see Figure 2 Medical care centres—growing numbers), with ca. 4800 staff physicians—compared to the total of 130,000 doctors who work in ambulatory care in Germany. Among them are about 793 general practitioners and 488 internists—making primary care physicians the largest specialty group working in this type of health care delivery system [32, p.3, 7].

Bottom Line: Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult.Recent policy reforms improved framework conditions for new forms of care.Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

View Article: PubMed Central - PubMed

Affiliation: Bertelsmann Stiftung, Carl-Bertelsmann-Str. 256, 33311 Gütersloh, Germany.

ABSTRACT

Problem statement: Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult.

Description of policy development: Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and 'community medicine nurses'.

Conclusion and discussion: Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

No MeSH data available.