The head of statutory health insurance physicians expects more self-pay appointments for those with statutory health insurance

According to Andreas Gassen, head of statutory health insurance physicians, those with statutory health insurance must be prepared to pay for treatments themselves due to fee cuts in order to avoid longer waiting times.

“Nobody can expect that the practices will simply carry on as before in view of the cuts,” Gassen told the editorial network Germany. “I assume that there will be offers for private consultations, so every appointment will be reimbursed,” said the head of the National Association of Statutory Health Insurance Physicians (KBV).

“People with statutory insurance who choose this option will then be treated like a private patient outside of statutory insurance, but will have to pay the costs out of their own pocket as self-payers,” he said.

Requirement for financial viability

This is the only way to finance the costs of additional cases beyond the budget. “The practices don’t have an infinite performance obligation,” says Gassen. “If specialist groups lose 25 percent of their sales, which is sometimes the case, that is a threat to their existence,” says the KBV boss. “If the budget is used up, patients will have to accept that they may not be able to get an appointment at their preferred practice until the next quarter,” he said. The budget will then be available again.

Gassen appeared willing to compromise on the question of the extent to which doctors will have to report available appointments in the future. “It would be conceivable to agree with the health insurance companies a quota for really urgent medical appointments,” he said.

However, Gassen set one condition. The following must apply: “Whoever orders, pays. If we guarantee appointments, the health insurance companies must guarantee the remuneration in return - regardless of whether the patient comes or not,” he warned. “Nobody can expect independent practices to keep appointments free so that they can end up twiddling their thumbs.”

ENT, orthopedics, cardiology, radiology, rheumatology

The federal government's savings program for statutory health insurance provides for extensive cost-cutting measures. According to the KBV, the outpatient sector is particularly badly affected.

According to Gassen, the areas of ENT, orthopedics, cardiology, radiology and rheumatology are particularly affected by the fee cuts amounting to three billion euros. There will be fewer appointments, especially here.