Table 2 Summary of the differences between the health care contracts
Usual care | General practitioner program | Specialists’ program | |
|---|---|---|---|
Gatekeeping | none (i.e. free choice between all health care providers that are licensed to bill their services to a SHI) | commitment to first seek help from one particular GP enrolled in the program (exception: e.g. emergencies, gynecologist) free choice between specialists if patients are referred by the GP | commitment to first seek help from one particular GP enrolled in the program (exception: e.g. emergencies, gynecologist) free choice between participating specialists if patients are referred by the GP |
Differences in the organization and payment of psychotherapy | The first 5 preparatory sessions are compensated to a lesser extent (64 €) when compared to regular sessions (84 €) • review process for approval of long-term psychotherapy • more highly frequented therapy possible for people with severe mental disorders (max. 80 h for behavioral therapy, max. 100 for psychodynamic therapy and max. 300 for analytic therapy) • waiting time until initial assessment on average approx.. 11,4 weeks in BW [43] | The first 5 preparatory sessions are compensated to a lesser extent (64 €) when compared to regular sessions (84 €) review process for approval of long-term psychotherapy more highly frequented therapy possible for people with severe mental disorders (max. 80 h for behavioral therapy, max. 100 for psychodynamic therapy and max. 300 for analytic therapy) waiting time until initial assessment on average approx.. 11,4 weeks in BW [43] | stepped payment scheme (105 € for urgent cases for max 10 sessions, 90€ for the following max 20 sessions, 84.5€ for the following sessions) higher payment for group psychotherapy after 60 h of therapy only therapy with a low frequency (max. 6 times per quarter) is billable (exception: personality disorders or if the diagnosis changes), application for an extension (e.g. to prevent relapse) is possible start of psychotherapy within 4 weeks after established diagnosis, for acute cases: initial session within 3 days; start of psychotherapy within 7 days after established diagnosis |
Differences in the organization and payment of psychiatry | Psychiatry: additional supplement (e.g. for counseling, prescription of discounted medication), limit of waiting time to 30 min, for acute cases: first appointment within the same day | ||
Differences in the organization and payment of neurology | Neurology: additional supplements (e.g. Multiple Sclerosis counselling: 6 units of 20 min per year, provision of assistants), limit of waiting time up to 30 min, for acute cases: first doctor’s appointment within the same day |