Primary care system: Hofmeister warns against “simple solutions”

Berlin. Better patient management through a primary care system? This approach, which also features in the coalition agreement and is to be incorporated into a bill in 2026, certainly has its appeal.

However, the implementation will not be easy, points out Dr. Stephan Hofmeister, Vice Chairman of the Board of the National Association of Statutory Health Insurance Physicians (KBV).

"It was not for nothing that we said from the outset that this is a very important issue, but at the same time one that carries a great deal of responsibility," Hofmeister told journalists in Berlin this week. "Simple solutions" are out of place.

Gatekeeper variant? Hardly!

First, we need to agree on what is meant by control. "One option is to restrict supply: a bottleneck towards the citizens – and someone sits there as a gatekeeper."

This is a form of control practiced in Scandinavia, for example. He doubts that local politicians will have the courage to copy the model.

It's also unlikely that patient management will make outpatient care more cost-effective, Hofmeister says. Costs for medications and diagnostics are exploding—so the system won't become "cheaper." However, patient management could help make care more sustainable.

This means: “We must try to bring patients and practitioners together in the best possible way and not have the patient in the wrong place at the wrong treatment level at the wrong time.” General practitioners’ practices are particularly well-suited for this type of management – without question.

Exceptions to the rule

However, Hofmeister says that establishing a mandatory primary care system has its pitfalls: Everyone wants to go to the "nice primary care physician" and not the one nobody can stand. Ultimately, you have to assign patients based on zip code, because one colleague simply can't treat 2,000 patients while another can only treat 100.

If the primary care system were implemented voluntarily, it would be "a tariff." The family doctor-centered care (HZV) in Baden-Württemberg is also a tariff. In this respect, the health insurance companies are responsible for setting up such tariffs – family doctor first tariff, orthopedic tariff, etc. – together with the contracted physicians.

It is also clear that exceptions to the control through general practitioners' practices are necessary: for example, for visits to an ophthalmologist, a psychotherapist, or for chronic patients who regularly receive specialist care . A patient undergoing dialysis, for example, does not need to visit their general practitioner just for a referral.

Expansion of the 116 117

With regard to acute cases, the 116 117 care platform is clearly the "right solution." According to a survey, 60 percent of citizens are already familiar with the hotline.

Since the number is mentioned in the coalition agreement, the KBV is offering politicians the opportunity to expand 116 117 into a nationwide platform for "appointment scheduling and care management." Admittedly, the KBV wants this upload to be supported with state funds, as board member Dr. Sibylle Steiner emphasizes.

A “Practice Future Act” would not only support investments in the technical infrastructure of 116 117, but would also support practices in digitization, Steiner also said this week in Berlin.

This is also how politicians handled the digitalization of hospitals – see the Hospital Future Act (KHZG), which was passed in 2020 and through which €4.3 billion was made available to hospitals for digitalization. (hom)