Führt das Hausarztmodell zu mehr Gleichheit im Gesundheitssystem?

Abstract

This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

Regional and patient-related factors influencing the willingness to use general practitioners as coordinators of the treatment in northern Germany - results of a cross-sectional observational study

“…Vice versa, our study revealed higher commitment to the GP for patients from rural areas. Investigations of the HzV in Germany by Schnitzer et al and Kürschner et al report that older patients or retirees participate more often in GP models [10,11]. The age effect could not be clearly determined by our study because, depending on the statistical model, there was at times a correlation and then again no correlation with the commitment to the GP.…”

“…There is a higher ratio of patients participating in HzV in less favoured rural areas. City dwellers, however, participate less frequently in HzV [10,11]. Aside from the influence of the region where the patients live, participation in HzV is also associated with patient factors, eg, advanced age or existing chronic medical conditions [12].…”

Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

“… 24 Our results, however, differ from the effects of specific general practitioner-centred healthcare models. 25–27 The evaluation of these models showed an increase in GP and specialist contacts when patients were enrolled. However, selection mechanisms of patients with higher morbidity, recall bias in interview surveys, or changes in patients' or physicians' behaviour might complicate the interpretation of such effects.…”

Rethinking primary care’s gatekeeper role

“…38 In France, incentives that promote gatekeeping worsen access to specialists, particularly for poor and uninsured people covered by complementary insurance. 39 However, evidence from European countries shows that gatekeeping helps reduce healthcare inequalities, [18][19][20][21][22] provides decision making support to disadvantaged groups, and lessens unnecessary specialist use by advantaged groups, 40 who tend to use specialty medicine more often. 18 22 …”

“…Money saved on access to specialists is spent elsewhere in the system (eg, increased use of emergency departments) 12 Leads to lower use of health services and lower expenditures 7 -11 Hinders patients from seeing a specialist when they sense their case is not resolved by the GP Reduces waiting times to specialists Negates the ethos of patient choice, empowerment, and shared decision making System cannot sustain everything patients want and needs to have referral mechanisms GPs treat only simple and general cases, which hinders clinical knowledge Ensures that specialists see more complex cases, hence building expertise May impair clinical outcomes because of delayed diagnosis 14 -17 Increases patient safety and protects patients from adverse effects of overtreatment 1 13 Increases inequalities [18][19][20][21][22] Reduces inequalities 18 -20 Preserves the traditional GP-specialist divide, hindering collaborative working Referral system increases the flow of information and mutual communication between general practitioners and specialists…”