Federal Council meeting on 5 July 2024. /picture Alliance, Carsten Koall
Berlin – Last Friday, the Federal Council dealt with the planned Health Care Strengthening Act (GVSG) in an initial discussion. The four committees involved – Health, the Committee on Labor, Integration and Social Policy, as well as the Family and Senior Citizens and the Committee on Home Affairs – presented a 51-page document with requests for amendments.
These include many suggestions that were included in the original bill of the Federal Ministry of Health (BMG) were included, but were removed again after discussions within the coalition for the cabinet decision.
Among other things, the federal states are demanding the return of the health kiosks. As previously provided, these should be able to be set up by the municipalities together with the state associations of health insurers.
The states also define the possible tasks of the health kiosks: They must be able to be installed in “regions and districts with a high proportion of socially disadvantaged people”.
Municipalities can work here with state associations of health insurers and replace the insurance funds; 50 percent of the financing should be borne by the health insurers and 44.5 percent by the municipalities involved; private health insurance companies should contribute a further 5.5 percent.
The kiosks should be linked to existing counseling centers “or facilities where health services are already provided and also provide digital and telephone services,” the bill says.
The original plan for primary care centers is also back up for debate at the proposal of the Federal Council. According to the states, “depending on regional needs, pediatric, gynecological, and psychotherapeutic medical care should be offered, and, depending on regional needs, other basic medical care, in addition to general medical care.”
Centers may be sponsored by physicians, professional associations, or health care centers, as well as recognized practice networks. An interprofessional team should have at least one full family physician care assignment, plus other nurse specialists and, depending on size, care assignments from other specialist groups.
According to the states’ idea, the centers should enter into a cooperation agreement with the respective municipality and the local public health service in order to be able to offer prevention and advice.
The National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds For this “new care approach”, the task is to “specify the legislative concept of primary care centres and regulate the details”, says the explanatory memorandum of the law. This also includes the remuneration and the necessary staff.
Health regions according to paragraph 140b should also be included in the law if the states so wish. Municipalities can conclude a contract together with health insurance companies in order to “ensure needs-oriented, cost-effective and high-quality regional intersectoral care” or to remedy “regional deficits in health promotion and prevention”.
The federal states are also calling on the federal government to reform the regulations for health care facilities (MVZ). This involves the establishment of municipal MVZs as well as investor-oriented MVZs. For the latter, the federal states submitted detailed proposals in June 2023 and called on the federal government to pass an “MVZ regulatory law”.
The legislative proposals of the Federal Council also contain other issues related to assistance: the associations of statutory doctors of health plans and health insurers are called upon to increase the funding of continuing education places in the area of pediatric and adolescent medicine.
“The financing of continuing education in pediatric and adolescent medicine must be made viable in conjunction with the financing of continuing education in general medicine without a maximum number of financing entities”, write the states.
At the request of the states, the nursing professions should also be strengthened in their professional representation in the GVSG. Nursing should have the right to vote in the Federal Joint Committee (G-BA) receive. The Federal Government is also called upon to examine whether the various professional nursing organizations can be given a stronger and more binding form of participation in the Federal Joint Committee through a different legislative procedure.
In a new call for change, the states are calling on the federal government to pursue a legislative process for an adequate funding structure for outpatient continuing education for psychotherapists specializing in outpatient care, as well as for the hospital-based portion of continuing education.
The GVSG regulations previously requested by the federal government are not sufficient “to financially secure continuing education,” the states write. The outpatient part in particular is not being sufficiently taken into account. The federal government must ensure that there are not too few outpatient training places due to a lack of financial security.
Since the law does not require approval by the Bundesrat, the states initially only submit a declaration. The federal government’s response to the states’ requests is expected on July 17. © bee/aerzteblatt.de