German doctors' leader says patients may have to pay privately for faster appointments

Self-pay option for faster appointments

Andreas Gassen, chairman of the Kassenärztliche Bundesvereinigung (KBV), told the Redaktionsnetzwerk Deutschland that statutory insurance patients should expect to pay for some treatment themselves to avoid longer waiting times. He expects private consultation hours to be offered, because every appointment in that setting is paid. Patients who take up this option would be treated outside statutory insurance, like private patients, but would cover the costs out of their own pocket. According to Gassen, this is the only way to finance additional cases that go beyond the budget.

“I assume there will be offers in private consultation hours, because every appointment there is paid.”

Three billion euros in cuts

The fee reductions total three billion euros, and Gassen said the impact will be uneven across specialties. He named ENT, orthopaedics, cardiology, radiology and rheumatology as the areas most affected, and expects fewer appointments in those fields. Once the budget is used up, patients may have to wait until the next quarter for a slot with their preferred practice, after which the budget becomes available again. Gassen said some specialist groups are losing 25 percent of their revenue, which he described as follows:

“If specialist groups lose 25 percent of their revenue, which is sometimes the case, that is an existence-threatening cut.”

He stressed that practices have no unlimited obligation to provide services, and warned that the cuts strain the sustainability of individual practices.

Conditions for free appointment slots

Asked how many free appointments doctors should keep available, Gassen was open to a quota for medically urgent appointments, to be agreed with the statutory health insurers. He attached one firm condition to that offer. In his view, whoever orders a service pays, and independent practices cannot be asked to keep slots free only to sit idle. He said that if practices guarantee appointments, the insurers must in return guarantee the fees, whatever the patient does.

“If we guarantee appointments, the health insurers must in return guarantee the fee, regardless of whether the patient comes or not.”

Savings programme and contribution rates

The cuts form part of the federal government's savings programme for statutory health insurance, which includes extensive measures. According to the KBV, the outpatient sector is particularly hard hit by the programme. Many practices have posted notices in their waiting rooms stating that if fees are cut, insured patients will find it harder to get appointments. The measures are intended to slow a sharp rise in statutory health insurance contributions, which insured people fund from their wages and salaries. Under the planned cuts, the budget for each period is set in advance, so additional cases beyond it are not covered by statutory funds.