[Who should decide on applications for medical rehabilitation? A critical reappraisal of the proposals of the Advisory Board on Concerted Action in Health Care].
Summary. In Germany the allocation of rehabilitation services depends on a decision of one of the social insurance funds. This decision is taken on the basis of an assessment of the application file by a physician of the fund. The general practitioner who may be the best informed professional as to the patients' disability, has no decision power in this allocation process. In 2001, however, the prestigious Advisory Board to the Ministry of Health proposed to leave the allocation to the general practitioner or another physician in office practice, thus restricting the role of the fund to verifying the appropriateness of the decision of the GP. This proposal is reviewed on the basis of the results of a survey among all general practitioners in the four Länder of Hamburg, Schleswig-Holstein, Mecklenburg-Vorpommern and Sachsen-Anhalt (n = 2110; response rate of 46%) done between 1999 and 2001. Furthermore, several steps and measures are proposed in view of increasing the involvement of the GP in the allocation process and of improving the communication between the funds and the general practitioners.
van den Bussche
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Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg. bussche@uke.uni-hamburg.de
Dunkelberg
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D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005194:Family Practice / Q000331:legislation & jurisprudence; D005858:Germany; D006801:Humans; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence; D012046:Rehabilitation / Q000331:legislation & jurisprudence*; D040841:Resource Allocation / Q000331:legislation & jurisprudence*