A new proposal has emerged in the ongoing debate surrounding improved healthcare management and increased patient financial contributions. Andreas Gassen, chairman of the Association of Statutory Health Insurance Physicians (KBV), has suggested a potential solution to address concerns about restricting direct access to specialists.
The proposal outlines the introduction of an optional “specialist tariff” for individuals who wish to continue bypassing the referral system – either direct referrals from a primary care physician or a digital initial assessment – and accessing specialists directly. This supplementary tariff is estimated to cost between €200 and €350 annually.
Gassen acknowledged the rationale behind the current coalition government’s plan to prioritize primary care physician referrals, particularly for older individuals with complex medical needs and chronic conditions. However, he emphasized that this system may not be universally suitable, with younger individuals potentially perceiving the requirement for a preliminary visit to a general practitioner as unnecessary. “Those who opt for the specialist tariff will retain the freedom of choice and continue to be able to directly consult with specialists” he stated.
The proposed tariff would not be required for patients referred to specialists by a primary care physician or when a specialist visit is digitally recommended. Gassen stressed that the urgency of the medical condition would remain the determining factor in the scheduling of these appointments.
He argued that the established referral system has not demonstrably reduced the demand for specialist appointments. Instead, existing models indicate that specialist access remains consistent. “Only when specialists receive a financial incentive for increased workload will they be able and willing to offer more appointments” Gassen explained. Revenue generated from the specialist tariff would be earmarked to compensate specialists for the additional appointments, addressing the current cost containment measures that limit the reimbursement rate for specialist services.
Regarding suggestions for a flat fee of €200 for each direct specialist consultation, Gassen deemed the amount excessive. He pointed out that a specialist consultation currently costs the statutory health insurance system between €60 and €75 per quarter.