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The story
The head of Germany’s Association of Statutory Health Insurance Physicians (KV) has reportedly predicted that patients with statutory health insurance (GKV) will increasingly need to pay out of pocket just to land a specialist appointment going forward. Germany runs a dual system of statutory insurance (GKV) and private insurance (PKV), and it’s well known that wait times for specialists can differ wildly depending on which type of coverage a patient has—even for the exact same condition. In Lemmy’s German-speaking community, a wave of personal stories described waits ranging from six months to over a year, fueling anger over what many see as the structural sidelining of statutory-insurance patients.
Head of Physicians’ Association Expects More Out-of-Pocket Appointments for Statutory Insurance Holders
Source: tagesschau.de / Read the original article here
What people said
The doctor said, 'I can write you the referral, but you should know you won't get an appointment for 9 months.'
Then, after hearing we'd vacationed in Thailand over the summer, the doctor said, 'Honestly, you'd be better off seeing a dermatologist over there next time!'
…Thanks a lot.
At this rate, maybe I should preemptively book an appointment for my kid today (I don't have a kid, though).
Meanwhile a coworker with private insurance (PKV) got a checkup appointment in two weeks. This system is completely broken.
Honestly, the smart move is to get your kids seen by every specialist now while you still can, so they're already on file as an 'established patient.' That way, next time around, they'll jump the queue by several months.
Uh, before we get to that—why not just raise the budget???
Step 2: book a gynecologist appointment.
Step 3: appointment's in 9 months.
Background and Key Points of This Discussion
Outpatient care in Germany is delivered by independent practicing doctors (Kassenärzte), and reimbursement for treating statutory-insurance (GKV) patients is capped by a fixed budget. Once a practice exceeds that cap, treating more patients becomes a financial loss for the practice, which creates a built-in incentive to push new GKV appointments further back in the queue. The association head’s comments reflected an industry forecast that more of these over-the-cap patients will be shifted toward paying out of pocket (Selbstzahler) going forward. Throughout the thread, numerous firsthand accounts described gaps of several months to over a year between GKV and PKV (private insurance) wait times for specialists, and many pushed back against the premise of the original report—that this is a problem the reform will cause in the future—insisting instead that “it’s already this bad right now.” At the same time, neither the article nor the thread ever pins down whether the budget overruns stem from a doctor shortage or from how funds are allocated, so no clear conclusion emerged.
*This article is an edited, condensed translation of the thread “Kassenärzte-Chef erwartet mehr Selbstzahler-Termine für gesetzlich Versicherte” from the overseas forum Lemmy c/dach. Responsibility for the translation rests with this site.
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