[Overview of the Organization of the Emergency Medical Service in Germany: What is the Basis for the Hospital Restructuring Act and the Supply Enhancement Act?].

UNLABELLED

In response to the increased use of emergency rooms, the increasing cost pressure on hospitals and the growing difficulty of filling emergency services in structurally weaker areas, the introduction of central practices (Portalpraxen) has been decided at federal level. Several Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen (KVen)) have already started to transform the medical on-call service before this legislative change and are now at different stages of the reform process. At many hospitals there are already so-called standby duty clinics (BDP). For the assessment of the current reform status as the basis for the Hospital Structure Act and the Nursing Reform Act, the present study aims to provide an overview of the organizational forms of the on-call medical service in the respective districts of the Associations of Statutory Health Insurance Physicians.

METHODS

All 17 KV districts were contacted by telephone and/or in writing in order to conduct a semi-structured interview along 3 dimensions: the general organizational structure, the personnel (above all physicians) and the supply mandate. KV Brandenburg, KV Hamburg and KV Nordrhein (subsidiary Gesundheitsmanagementgesellschaft mbH) completed the questionnaire.

RESULTS

In the districts of Hesse, Schleswig-Holstein, Thuringia and Westphalia-Lippe, at the time of the 2017 survey, the out-of-hour service was exclusively organised in emergency service practices. Baden-Wuerttemberg, Lower Saxony, North Rhine, Rhineland-Palatinate and Saarland have extensively introduced emergency service practices. However, the traditional service remains present in some regions. There are huge organisational differences between metropolitan and rural areas reflecting various challenges: Bavaria, Brandenburg and Mecklenburg-Western Pomerania only established emergency service practices in major cities due to economic considerations.

CONCLUSION

Emergency service practices provide a way to address the challenges of physician shortage and patient control. With their flexibility regarding the organization, they are adaptable to regional differences and are already playing a major role in assuring out-of-hour medical service in Germany.