Martin Holl had heart problems, swollen legs and muscle weakness. Alarm bells went off for the 68-year-old. "I've done a lot of sport and I think I know my body and especially my muscles," he says. "And then I was suspicious."
A case for the cardiologist? No. Martin Holl first went to see his family doctor - because he had to. The pensioner takes part in the “family doctor-centered care” (HZV) model. This exists to some extent in all federal states, but nowhere is it as widespread as in Baden-Württemberg. The system was introduced in 2008, and over a third of those with statutory health insurance in the country now take part, a total of 3.4 million people. Trend according to the General Practitioners Association: recently rising sharply.
The concept stipulates that participants generally undertake to first go to their family doctor. He will provide initial care - if you need an examination by a specialist afterwards, he will refer you to a specialist.
In return for the limited freedom of choice, Martin Holl's family doctor Joachim Kolb in Benningen near Stuttgart promises faster appointments. "When patients ask me why I should do this at all, I say that I can guarantee them that I will ensure that, if it becomes urgent, they will receive treatment promptly."
This is made possible by the short official route to specialists in the area and the contact at eye level. A doctor can often explain to a colleague much better why a case is urgent. Then you can often get an appointment with a specialist within two days. Even if there are differences between the disciplines and, in his opinion, significantly more practices should take part.
There is currently no scientific evidence that HZV patients actually get a specialist appointment more quickly. Because waiting times are determined by many different factors, says health economist Silke Arnegger from RheinMain University of Applied Sciences. In addition to coordination, the availability of specialists in the area, the organization in the practices and digitalization also play a role. “Family doctor-centered care alone cannot solve this,” she says.
The federal government is nevertheless convinced of the model. Former Health Minister Nina Warken included it in her list of reform projects under the name “primary care,” and her successor, Carsten Linnemann, promised just last week to present a draft bill this fall. The goal: The entire system should become more efficient, patients should be managed better and specialists should be relieved of their workload.
Baden-Württemberg is a good role model, says economist Arnegger. The actors in the country consistently defined the framework conditions when the system was introduced. "This means that it is precisely determined when the family doctor refers to a specialist, when the patient is referred to the hospital by the specialist or when the patient is sent back to the family doctor by the specialist." She sees the benefit primarily in better patient management and possible cost savings.
A current evaluation of family doctor-centered care by the universities of Frankfurt and Heidelberg shows: Patients in the model visit the family doctor's practice more often, but there are significantly fewer uncoordinated contacts with specialists.
Family doctor Johannes Kolb says: He can treat eight out of ten patients himself without them having to go to a specialist. The model means he has more work, but he also receives more money from the health insurance companies. And he can do a lot more because his professional field has been significantly upgraded - even small surgical procedures. “This gives me a level of job satisfaction that I could wish for everyone,” says the general practitioner.
Patient Holl has to go to a cardiologist for further checks because of his heart problems. He doesn't regret having to go to the family doctor first. "He is the doctor I trust and I appreciate that at a certain point he says, here are my limits, here perhaps the expertise of a specialist is needed." As always, his family doctor will contact him directly and try to get an appointment for his patient quickly.
