[Need for nursing care--severely disabled patients. Problems in determining disability prerequisites in legal health insurance].
The report describes the legal and administrative regulations concerning the medical examination of the new Leistungstatbestand "Schwerpflegebedürftigkeit" (i.e. a situation characterized by "urgent need of nursing care"). The numbers of applicants and the results of the medical examinations during the period 1989-1992 are also reported. The main difficulties consist in clarifying the meaning of some important legal terms and the relatively vague formulations of the administrative guidelines. Another important aspect is seen in the fact that the result of the medical examination is largely dependent on the informations supplied by the patients or their relatives. Two case reports are presented for the purpose of demonstrating these difficulties. Finally short reports of the first few judgements regarding the definition of situations with "urgent need of care" by different social-courts of appeal are presented.
Piechowiak
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D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control / Q000331:legislation & jurisprudence; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence*; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D005260:Female; D005858:Germany; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D007353:Insurance, Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged