[General practitioner-centered care: a model with potential for improvement?]

Area of Science:

• Health Services Research
• Primary Care Policy
• German Healthcare System

Background:

• Introduction of GP-centered care in German outpatient settings via GKV Modernisation Acts (2004, 2007).
• Implementation through selective contracts (§ 73b SGB V) between management companies (e.g., HÄVG) and statutory health insurance funds (GKV).
• Voluntary participation for physicians and patients, with AOK/MEDI Baden-Württemberg as a notable large-scale example.

Purpose of the Study:

• To evaluate the advantages and disadvantages of GP-centered care models in Germany.
• To assess the impact of selective contracts on primary care and the medical profession.
• To propose improvements for strengthening long-term primary care.

Main Methods:

• Analysis of the contract landscape and participation data in GP-centered care in Baden-Württemberg.
• Qualitative assessment of reported advantages (remuneration, care control, continuity) and disadvantages (administrative burden, economic focus, exclusivity).
• Examination of the implications of selective contracting on the broader medical profession.

Main Results:

• GP-centered care offers higher remuneration, improved care control, continuity, and reduced misallocations, strengthening the GP's role.
• Disadvantages include increased administrative burden, a predominantly economic focus in contracts, and exclusivity to general practices.
• Selective contracts risk dividing the medical profession and jeopardizing medical freelancing.

Conclusions:

• To enhance primary care, collective contracts need expansion and improvement via add-on contracts, ensuring specialists' full participation.
• Budgeting should not unilaterally transfer morbidity risk to physicians.
• A robust primary care system requires transparent design and close collaboration between internists and specialists.