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German Physician Reimbursement System Places Barriers to Accessing Outpatient Care for Publicly Insured Patients

Country Correspondent: Michael Laxy

A recent study from Hamburg University shows that German patients with public insurance often do not receive needed outpatient care at the end of each annual quarter. Researchers saw a 19 percent increase in emergency department visits in the final weeks of March, June, September, and December, because patients could not get appointments with their regular doctors. The authors attributed this to the way German providers are paid, which relies on prospective budgets that cap the number of outpatient procedures that providers can be reimbursed for each quarter. Once the quarterly budget has been used, doctors are incentivized to limit care because they will not be reimbursed for additional services. In contrast, privately insured patients, for whom quarterly budget restrictions don’t apply, continue to receive services at the same rates regardless of the time of year (approximately one in 10 Germans are privately insured).


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