Explosive study: Always going to the family doctor first is more expensive

The federal government wants to achieve two goals with this so-called primary doctor model. She wants to shorten the long waiting times for specialist appointments. Anyone who really needs to see a specialist should get there more quickly in the future. The idea is that control by general practitioners prevents many unnecessary visits to the doctor. This could also save health insurance companies some money.

But a new study is now questioning these basic assumptions. The Hamburg health economist Jonas Schreyögg looked at the effects of so-called family doctor-centered care at the Techniker Krankenkasse (TK).

More specialist visits instead of fewer

In addition to the standard tariff, all statutory health insurance companies must already offer a model in which their insured persons usually first go to their family doctor and are referred by him. Schreyögg now shows that this model caused additional costs for TK in the years 2015 to 2024 in 13 federal states examined and even led to more visits to specialists. The number of hospital stays has not been reduced either.

Overall, the family doctor-centered care, which ten percent of insured people currently opt for, results in additional costs of 160 million euros per year for the TK compared to standard care. As a result, the fund’s contributions increased by 0.05 contribution points, says the deputy chairman of the TK board, Thomas Ballast.

For the study, the care of TK insured people with a family doctor contract was compared with a comparison group in the standard tariff. There is no difference in terms of age and health status.

Surprisingly, those insured in the family doctor-centered care model went to the family doctor slightly less often on average than the comparison group and went to a specialist 1.2 times more often per year. It is not clear that they would have benefited from the family doctor model in terms of health. This meant that hospital stays could not be avoided, nor did insured people with a family doctor contract die less often. Insured people in the family doctor model are also more likely to be on sick leave. On average, they receive sick pay for four days longer.

Schreyögg also attributes the lack of positive effect to the fact that patients in the family doctor model currently hardly have to fear any negative consequences if they go straight to a specialist. “More commitment in management leads to better care,” says Schreyögg, referring to the study results.

Patients who adhere to their family doctor’s instructions tend to be able to avoid unnecessary treatments. They visit their family doctor less often, do not have to go to the hospital as often and take fewer incorrect medications.

Schreyögg therefore does not advise the black-red coalition against the primary doctor system. When setting it up, however, attention must be paid to greater commitment, emphasizes the professor at the University of Hamburg. How it will be implemented is currently still unclear. Health Minister Nina Warken (CDU) can imagine, among other things, a special fee for a direct appointment with a specialist.

Inefficient system should continue to exist

In his study, Schreyögg also examined in detail why family doctor contracts for TK are more expensive than the standard tariff. For an insured person who chooses this model over a long period of time, it leads to an average cost increase of 122 euros per year. His family doctor receives 80.56 euros of this. Because they receive additional compensation for the intensive care of these patients.

In contrast, there are savings in specialist fees of just four euros. In addition, the TK also has to spend more money on hospital stays, medication, sick pay and medical and medical aids for this patient.

Schreyögg therefore recommends that the federal government abolish the family doctor-centered care model. In the current form, no recommendation can be made for this, he writes in the summary of the study.

According to the coalition agreement, this special tariff should be retained, although the primary doctor system will also be introduced for statutory health insurance patients with a standard tariff in the future. This would mean that the doctors participating in the model would continue to receive their special remuneration.

Thomas Ballast defends himself against these plans. “Such offers should only be a voluntary service for the health insurance companies,” demands the deputy head of the TK. In a uniform primary care system, a binding digital initial assessment will be needed in the future as the first point of contact for those seeking help, he says. It should be determined there what is best for the patient: first bed rest, an appointment with their family doctor or – for example in the case of an eye problem – a direct visit to a specialist.