Health insurance: block private patients appointments? Doctors say no

Many legally insured patients find the search for a doctor’s appointment as difficult and lengthy – today the Federal Council is therefore dealing with the allocation of appointments. The reason is an application for a fairer appointment system.

What is the Federal Council about?

The Lower Saxony Initiative aims to make the Federal Council an appeal: the next federal government should be asked to check whether there is an unequal treatment of legally and privately health insured. If so, according to the state government, new requirements are required – such as a minimum rate of appointments for legally insured or financial incentives for doctors, which mainly deal with legally insured persons. The country chamber consumes whether it provides this positioning with the federal government – also suitable for the ongoing coalition negotiations.

All citizens should have an equal access to faster, high -quality medical care, said Lower Saxony’s Minister of Health Andreas Philippi (SPD) – “regardless of their income, their place of residence or the question of whether they are private or statutory health insurance”.

Do private patients block the appointments?

No, says the CEO of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen. There is not enough private patients for that. Around 90 percent of people in Germany are legally insured. “Accordingly, the largest proportion of appointments by far no longer applies to them,” said Gassen. “In addition, the approximately ten percent privately insured go to the doctor much less often.”

The orthopedic surgeon sees in the Lower Saxony push “Pure Eywiping”: appointments that do not exist, or services that are not remunerated could not be enforced by law.

The top association of the statutory health insurance companies (GKV), on the other hand, complains of “discrimination against the legally insured persons against private patients in the allocation of appointments”, as Board Vice Stefanie Stoff-Ahnis said.

How long are the waiting times?

The KBV refers to an evaluation of the appointment service points on 116 117: Specialist dates were therefore placed on average within 12 days of the first request in 2023. The fastest thing was therefore the case with general practitioners (4 days), for example with pediatricians (9 days), ophthalmologists (11 days) or dermatologist (14 days). The KBV report shows the longest waiting time with an average of 26 days for endocrinology (hormonal medicine) and diabetology.

How do patients perceive the waiting times?

Almost every third legally insured person (31 percent) feels the waiting for a specialist date than too long – and every fourth is waiting for more than 30 days. This is the result of a representative survey of 2024 on behalf of the GKV top association. The general practitioners also cut off better in this survey: there only 12 percent kept the appointment times too long.

What problem do the doctors see?

KBV boss Gassen calls for a binding appointment for everyone involved. Often patients would not appear even though they have an appointment. The KBV boss said that the doctors would therefore have to be automatically remunerated by legally insured patients: “It is not just a date in the calendar like a hairdresser appointment, but about coordination of care.”

What do the health insurance companies want?

The focus is on digital appointment agency for the GKV top association, for which the doctors would have to provide a certain number of hours of hourly without discrimination depending on the specialist group – regardless of the insured status. “If you want real equal treatment, you have to ensure that when making an appointment, you can no longer ask whether someone is insured by law or privately,” said Board Vice-Vice Stoff-Ahnis. “I hope that the new federal government will accept the topic promptly and will not be tried again in vain to solve the problem with more and more money for the medical profession.”