Family doctor model: advantages, disadvantages, application, cancellation
What initially only some private health insurers introduced has also been available from statutory health insurers for some years: the GP model. As the name suggests, the primary care physician plays a central role. Patients see him first and are referred to a specialist as needed. You can save quite a bit. How it works, for whom it is worthwhile, how you can cancel, as well as the advantages and disadvantages – you can find all this out here.
How does the family doctor model work?
In principle, there is a free choice of doctor in Germany. This means that a patient is free to choose his or her own physician and may also seek a second or third opinion. He can go to a general practitioner as well as to a specialist. However, the costs for a specialized doctor are usually significantly higher. Since health insurance is compulsory in Germany, the patient does not notice these costs. But the statutory and private health insurance companies.
For this reason, in the 1990s, some private health insurance companies began offering special and discounted rates if an insured person first sees a general practitioner – also known as a family doctor. The doctor then examines the patient and only if the required therapy exceeds his medical possibilities, he refers the patient to a specialist.
Since 2004, statutory health insurers have now also been required to offer the family doctor model. So TK, AOK, Barmer, DAK and co. Those who choose to do so agree for at least one year to always see their primary care physician first if they become ill (except in an emergency).
Am I automatically insured under the GP model??
As an insured person, you are initially not automatically integrated into the family doctor model. While it is obligatory for health insurance companies to offer a family doctor model – regardless of whether it is TK, Barmer or other insurance companies. However, participation is voluntary for you.
With the family doctor model, you consciously choose a specific general practitioner or internist who virtually “wears the hat” in the treatments. He is the expert who performs extensive examinations as far as he is able and only makes a referral in case of emergency. Nevertheless, as the central point, he always keeps track of the treatment and the progress of recovery.
This gives him back the importance he has traditionally held for a long time anyway. Only with the introduction of the chip card in 1992 was this lost. Since then, patients have been able to switch from doctor to doctor more easily. With the family doctor model, however, he or she is once again the pilot and confidant in the health care system.
This is why the family doctor model was introduced
The background to this is the fact that, especially in the area of cardiovascular diseases, a general practitioner can already achieve a great deal. However, patients have increasingly sought out cardiologists in recent decades. The general practitioner model was well received, especially by younger insureds, which was mainly due to the significantly cheaper premiums.
Since the health insurance companies can only vary with the monthly contribution rates to a limited extent, they also offer other advantages to the insured:
- Reimbursement of a part of the contributions
- Premium and bonus payments
- Exemption from co-payments for medications and examinations
This also facilitates the exchange between the doctors involved and avoids possible duplicate examinations. In addition, this model makes it possible to reduce waiting times with specialists.
In addition to emergencies, dentists, ophthalmologists and gynecologists are exceptions to this rule, and can still be seen directly without a referral under the general practitioner model.
Can I also cancel the family doctor model??
If you have opted for the family doctor model, you still have two weeks to change your mind. Within this period you can revoke the declaration of participation. After that you are bound to the general practitioner model for one year. Termination can therefore only take place after one year at the earliest.
If you decide to cancel the family doctor model, this must be done in writing. You do not have to justify your decision.
However, you should take a close look at the cancellation period in good time. This is noted in the declaration of participation in the general practitioner model. But you can also find it in the statutes of your health insurance company. Depending on the insurance company, this varies considerably and can be as long as three months.
What happens if I do not comply with the family doctor model?
If you participate in the family doctor model, you are obligated to adhere to the contract and always see the family doctor first.
If you go to another doctor anyway, it depends on which one you choose. You can change your family doctor within the family doctor model without any problems.
This makes sense, for example, if the relationship of trust is permanently disturbed. However, the new doctor must also participate in the general practitioner model.
Can I use the family doctor model without a referral to a specialist??
It is not so simple if you simply visit a specialist without a referral. In this case, you may be threatened with sanctions, depending on the insurance company and the declaration of participation.
In all likelihood, you will lose your financial benefits, unless it is an emergency case. In the worst case, however, you may be forced to pay for specialist treatment entirely yourself.
Advantages and disadvantages of the family doctor model
Opinions differ widely on the purpose of the family doctor model. The fact is: it offers both advantages and disadvantages. These weigh however in each individual case differently heavily.
Therefore, we cannot give you a clear recommendation pro or contra GP model. But a little help in deciding.
At first, the family doctor model sounds simple and practicable. And indeed, there are a number of advantages for everyone involved:
- One-stop shop ✓
Once the right family doctor has been found, he or she is the most trusted person to act as a central point of contact for his or her patients. He knows everything about each individual. Examinations and anamnesis do not have to be carried out within a certain treatment therefore each time anew. With the family doctor, there is one person who has an overview of the course of therapy and medication as well as the patient's life background at all times.
- Cost factor ✓
This also reduces costs: both for the insured community (i.e. the general public) and for the insured person. Because the savings can be partially passed on to the patient by the health insurance companies. In addition, additional early detection examinations can be reimbursed in this way.
- Special benefits ✓
Those who choose a family doctor model are tied to their doctor. In return, the latter can accommodate its patients. For example, by offering special consultation hours in the evenings or mornings, or by significantly shortening waiting times. Primary care physicians who participate in this model also often provide better and more detailed counseling services, as they are often specially trained to do so. For older or chronically ill patients in particular, it is an enormous added value.
But as nice as the family doctor model may sound – it does not only have advantages. Because it is not automatically suitable for every insured person. Therefore, you should think carefully before you decide on such a tariff and commit yourself in this respect for at least one year. The disadvantages are in detail:
- Lack of flexibility ✗
If you travel often, you'll have a problem with the GP model. What if a non-emergency checkup is needed on the road?? The patient must then look for a general practitioner locally who also participates in the general practitioner model. However, this person cannot continue to act as a pilot after departure – the whole model is reduced to absurdity in this case. The same applies in the event of a move or if your family doctor is on vacation himself. Then, for better or worse, you are bound to his or her representation, even if you don't trust it.
- Leveraging the free choice of doctor ✗
Through the family doctor model you are more or less bound to your doctor. They cannot easily get a second opinion from a doctor who is much more knowledgeable, but who does not participate in the general practitioner model as a specialist. In order to continue taking advantage of this tariff, you first need a referral, which means additional hassle, time and discussions.
For whom is the primary care physician model worthwhile?
For those who have found their trusted primary care physician anyway, the primary care model can already be well worth it. The AOK already found in 2013 in a study that the patients who chose this model were treated and examined more intensively. In this way, several hospitalizations could be avoided in the long run. In this respect, the family doctor model is particularly worthwhile for older patients who need to go to the doctor frequently, as well as for those with chronic illnesses.
But the model is also worthwhile for the health insurers and thus for the community of insureds: those insured under a family doctor model incur over twenty percent lower costs on average – and that despite an average of three more doctor contacts per year.
What does the model mean for the family doctor?
For the participating family doctor, the model can also be worthwhile. He has a better overview and can therefore plan more easily. So he also has less bureaucracy and can take care of their patients more intensively. In addition, the family doctors get more money for the more intensive consultation.
In return, however, physicians must agree to participate in regularly scheduled continuing education if they wish to participate in the family practice model. This includes technical and communication issues as well as billing issues. They also have to change their IT in the practice accordingly. Although this is a one-off expense, it still has to be taken care of and also means additional financial outlay.