[Access to Digital Health Applications - Prescription by Physicians vs Patient Requests Made Directly to Health...

In Germany, Digital Health Applications (DiGA) can be prescribed for mental illnesses since 2020. Patients with statutory health insurance can access DiGA in two different ways. They can either be prescribed by a physician or psychotherapist or patients can request them directly from their health insurance company. The aim of the present study was to shed light on the different ways of access especially with regard to their actual implementation.

Semistructured interviews were conducted with experts to investigate the current care situation with DiGA in the context of mental illnesses. The experts were representatives of patients, physicians and psychotherapists, statutory health insurance companies and DiGA manufacturers. The interviews were conducted online, recorded and transcribed. A qualitative content analysis according to Kuckartz was performed with MAXQDA.

A total of 13 expert interviews were conducted. Content analysis revealed three main topics: 1) relevance of direct authorization by the health insurance company, 2) implementation of direct authorization by the health insurance company, and 3) advantages and disadvantages of direct access. While direct access via the health insurance company played a minor role quantitatively, it has potential advantages such as a low threshold access or a greater patient autonomy. Disadvantages were seen in the transfer of therapeutic sovereignty from physicians and psychotherapists towards the health insurance companies. Problems were also seen in the lack of comprehensive therapy monitoring, inadequate diagnosis without or with inadequate consideration of contraindications, and additional effort on the part of health insurance companies.

The direct application for statutory health insurance-funded services from health insurance companies marks a new approach in the German health care system. While there are good arguments for and against patient self-referral, the current implementation needs to be scrutinized. Because of the need for a current indication and the possible exclusion of contraindications, patients usually have to visit a doctor or psychotherapist anyway, which significantly limits the benefits. Under the current conditions, the way of prescription is usually associated with fewer problems.