Identifying amount of required healthcare
The G-BA developed the needs planning directive (German: Bedarfsplanungs-Richtlinie) to give national rules on “how much” SHI-funded health care, i.e. clinicians, is needed in a certain location. The overarching goal is to offer people with SHI uniform access to outpatient health care. The target ratio of residents per clinician is calculated in a multi-step process based on the local age, gender, and morbidity structure.
Target ratio = Number of residents / 1 clinician
The morbidity factor accounts for the assumption that regionally higher morbidity links to a higher need for outpatient clinicians and psychotherapists in Germany:
- This means that in areas with higher morbidity than the national average, the general ratios are lower. Therefore, more positions are offered there.
- In areas with a lower morbidity than the national average, on the other hand, comparatively fewer clinicians and psychotherapists are needed; thus, the adjusted ratios increase accordingly.
Change of morbidity factor in Germany
The morbidity factor was introduced in 2019 and is updated every two years. In July 2021, the G-BA has now changed the morbidity factor used in this calculation for the first time.
Since the general German population has aged since 2010, the base target ratio was now reduced in several steps:
- Until the change, it was assumed that one GP would cover 1,671 residents; in the future, one GP only covers 1,607 residents.
- Additionally, regionally, patients are comparatively older and sicker than before. This means the target ratio was further reduced to one GP for every 1,344 residents.
This change in morbidity now means that an additional 260 positions for general practitioners can be advertised across Germany. However, it remains to be seen if these clinicians can be found and are willing to settle in the required locations. Filling these positions has become more and more difficult over the last few years, especially in rural areas, despite financial and other incentives.