The aim of the directive is to advertise placements for clinicians and dentists in the exact locations, where they are needed. The overarching goal is to offer people with SHI uniform access to outpatient health care that meets their needs.
With this needs planning directive (German: Bedarfsplanungs-Richtlinie), the G-BA specifies national rules on how to plan “how much” SHI-funded health care is needed (= needs planning) as well as how to identify over- or under-supply.
In particular, the directive includes the ratios (number of residents per clinician), details on the locations of these, and regional differences that justify a deviation from the national framework.
Needs planning tools
The G-BA defines a national planning system. The KVs and regional associations of SHI funds can then amend this national system to account for their regional differences. They compare the current health care supply level with the target level. If there is an undersupply, they will propose new positions for clinicians or dentists in their area. The G-BA makes the overall decision on how much the regional demand planning can deviate from the national system. In addition, there is the possibility to allow additional contract physicians through special needs requests to meet special local or qualification-related demands.
| Level | Tool |
|---|---|
| National Overarching general requirements for needs planning (clinician groups, basic ratios, morbidity factor, planning areas, etc.) | Needs planning directive (G-BA) |
| Regional Development of the needs plan according to the supply situation under consideration of regional differences (Calculation of regional ratios and of over- or under-supply, if necessary, adjustment of the planning areas, etc.) | Needs plan of SHI funds and KVs |
| Local Determination of local special needs in areas that are blocked at the regional level (allowances) | Special needs approved by allowance committees of SHI funds |
Each of the doctor groups planned with the guideline is assigned to one of these levels of care. The respective planning areas were defined in accordance with the Federal Institute for Building, Urban, and Spatial Research (BBSR). A distinction is made between central areas, districts, and so-called spatial planning regions as well as the districts of the associations of statutory health insurance physicians.
In their planning system, the G-BA applies different sizes of areas to different groups of clinicians. For example, family doctors or GPs should be based as close as possible to their patients. That means a very small area is applied to family doctors. For a specialist, it is considered appropriate that patients could travel a bit further. Overall, the rule is, the more specialized the clinician, the wider are their catchment areas.
Assessment of supply levels with ratios
The ratios, i.e. number of residents per clinician, express the target level of care supply. They are defined in the directive, differentiated according to four levels of care (see below). With a resolution from 16 May 2019, the G-BA introduced a multi-step calculation process to adjust the basic ratios to the local age, gender and morbidity structure. These target ratios determined in this way then form the basis for evaluating the local care situation and at the same time reflect how this compares to the national average.
Four levels of care
The directive differentiates between the following four levels of care:
- Family doctor / GP care
- General specialist care
- Specialized medical care
- Separate specialist care
Each group of clinicians is assigned to one of these levels. The catchment areas are differentiated into central areas, districts, and planning regions, as well as the districts of the KVs.
Family doctor / GP care
This group includes family doctors, general practitioners, or specialists in general medicine. This level has the smallest associated area because these clinicians should be based as close as possible to their patients. The planning takes place at the central area level.
General specialist care
This group of clinicians includes, amongst others, ophthalmologists, gynecologists, psychotherapists, and pediatricians. The planning happens at the districts level. There it is assumed, for example, that cities also cover care for surrounding areas. Thus, the expected ratio of clinicians is higher in cities than in rural areas.
Specialized medical care
This groups includes anesthetists, radiologists, specialist internists and child and adolescent psychiatrists. The planning area is the spatial planning region.
Separate specialist care
This last group includes, for example, human geneticists, laboratory doctors, nuclear medicine specialists and radiation therapists. These clinicians might work across all of Germany, have little or no patient contact or provide special medical services. Accordingly, the planning here is based on the district of the KVs.