Hausärztliche Versorgungssteuerung vor und nach Abschaffung der Praxisgebühr: Ergebnisse einer Routinedatenanalyse aus Bayern

Background: In order to strengthen the coordination by family physicians, a copayment was introduced in 2004. Due to a perceived lack of efficacy in comparison to high bureaucratic efforts, this copayment was abolished in 2012. This paper is a summary of the most relevant results of two internationally published articles that analysed the change of coordination after the abolition of the copayment. Methods: A retrospective analysis of anonymized claims data of the Bavarian Association of Statutory Health Insurance Physicians from 2011-2016 (2011/2012 with, 2013-2016 without copayment). The analysis included all statutory health insurance with a minimum age of 18 years and with residential address in Bavaria. A patient was considered to be ‘coordinated’ if every ambulatory specialist contact within a quarter occurred as a result of a family physicians‘ referral. Results: After the abolition, there was a substantial decrease in coordinated primary care in Bavaria, from 49.6 % (2011) to 15.5 % (2016). Comparing regional characteristics, urban areas showed higher decreases than rural areas. In terms of morbidity, the proportions of chronic and mental diseases increased in the group of uncoordinated patients. Conclusions: The results suggest that the copayment was a partly effective instrument to support coordinated primary care. After the abolition, alternative approaches are required to support coordinated primary care by family physicians.