title: [Accessibility barriers in the German health care system : Supporting and inhibiting factors when establishing medical centres for mentally and multiply disabled persons].
abstract: BACKGROUND
  In addition to primary and secondary special care, a special type of care was created in the 2015 German Health Care Strengthening Act [GKV-Versorgungsstärkungsgesetz]: medical care centres for adult people with mental and multiple disabilities (MCAMD). This closed a gap in the German healthcare system and part of Article 25 of the UN Convention on the Rights of Persons with Disabilities was implemented.
  
  
  OBJECTIVE
  Experiences from pilot projects are useful while implementing these centres. The issue is therefore: which are the supporting (s) and inhibiting (i) factors when establishing MCAMDs in the view of health care providers?
  
  
  METHODS
  Based on open guided expert interviews medical directors and initiators of existing and planned centres were interviewed. Data analysis was done by qualitative content analysis.
  
  
  RESULTS
  Healthcare providers think reducing barriers in people's minds is most important. In the course of approval procedures, reservations from different actors and institutions were considered (i). During financial negotiations, health insurance companies requested a characterisation of the target group using the ICD-lists, which doesn't comply with the needs of the users (i). Implementation was only possible with a great effort from the initiators paired with willingness from actors of the association of statutory health insurance physicians and the health insurances (s).
  
  
  CONCLUSIONS
  This paper describes the process used to implement MCAMDs. Potential centre providers can be inspired by these results. Further research on the process of implementation of these medical centres is needed, especially taking into account all involved parties.
authors: Fachgebiet Sozial- und Gesundheitsrecht, Recht der Rehabilitation und Behinderung, Universität Kassel, Arnold-Bode-Str. 10, 34127, Kassel, Deutschland. mirjam.schuelle@uni-kassel.de.
authors: Mirjam
authors: M
authors: Schülle
authors: Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland.
authors: Claudia
authors: C
authors: Hornberg
mesh_terms: D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation*; D005858:Germany; D006297:Health Services Accessibility / Q000458:organization & administration*; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration*; D009937:Organizational Objectives
keywords: Access to healthcare; Article 25 UN-CRPD; Implementation type; People with mental and multiple disabilities; Specialized medical care centres for adults