Wer wählt den Hausarzt zum „Gatekeeper“?

Abstract

Since July 2009, statutory health insurance companies in Germany are obliged to offer a so-called general practitioner model. By strengthening the general practitioner's position, these models should optimize healthcare especially for people with higher demands for health services. So far, little is known about which patients participate in the model. Our study's aim was to describe correlates of enrollment based on the behavioral model of health services use. The data were obtained from the Robert Koch Institute's 2006 telephone health survey. Variables influencing enrollment in the general practitioner models were determined through logistic regression models. Main indicators for enrollment were age above 60 years, lower social status, lower income status, and living in less populated areas. Insured persons with a higher demand for medical services were more often enrolled in general practitioner models. Most of them had consulted their general practitioner very frequently even before the general practitioner model was introduced.

Regional and patient-related factors influencing the willingness to use general practitioners as coordinators of the treatment in northern Germany - results of a cross-sectional observational study

“…The age effect could not be clearly determined by our study because, depending on the statistical model, there was at times a correlation and then again no correlation with the commitment to the GP. The presence of medically diagnosed conditions and belonging to the social middle and lower class are linked to more willingness to participate in HzV [10]. The results of our investigation imply similar correlations with the commitment to the GP.…”

“…Vice versa, our study revealed higher commitment to the GP for patients from rural areas. Investigations of the HzV in Germany by Schnitzer et al and Kürschner et al report that older patients or retirees participate more often in GP models [10,11]. The age effect could not be clearly determined by our study because, depending on the statistical model, there was at times a correlation and then again no correlation with the commitment to the GP.…”

“…On average, the patients' commitment to their GP was relatively strong, but there were large differences between patient groups. HzV is an already existing and tested intervention for increasing the commitment to the GP [10,11]. Since, however, particularly the groups with the least commitment to a GP also have the lowest willingness to participate in HzV, HzV in its present form seems to be least suited to appeal to the aforementioned patient groups.…”

“…There is a higher ratio of patients participating in HzV in less favoured rural areas. City dwellers, however, participate less frequently in HzV [10,11]. Aside from the influence of the region where the patients live, participation in HzV is also associated with patient factors, eg, advanced age or existing chronic medical conditions [12].…”

Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany

“… 10 GPs are more frequently consulted by patients who are elderly (>65 years), female, non-smokers, not economically active and have lower social status, higher morbidity and a poorer health-related quality of life. Kürschner et al 11 showed that the main indicators for enrolment in a general practitioner care model, where coordination of healthcare use is provided solely by GPs, were age above 60, lower social status, lower income status and residence in less populated areas.…”