Summary of developments in the cure system

The fall in birth rate, increase in life expectancy above 60 years, increase in chronic diseases and developments in technology has brought financial constraints to the GKV insurances and has forced them to resort to borrowing. These developments called for new reforms and resulted in insurees gaining the right to choose their own insurers. In 1992 and later in 2004 for almost all health services provided, the insured had to pay part of the expenses on his/her own. This, although reduced the debt of the insurance companies, the insured were not happy with it.

In the curative SPA system too, in order to reduce the debt, insurance companies started opting for foreign SPA services. Although this is welcome news for insurance companies under GKV, SPA operators in Germany are struggling and want this practice to be stopped. They defend the fact that a medium should be created for equal competition and that only SPA operators that are compatible with German standards should be given the opportunity to operate. They give a very striking example of Polish people needing only 8 weeks of training to become masons while Germans need 3 years of training.

Generally foreign curative SPAs are not approved by most insurance companies. However, there are developments on this issue too. Up to date, about 20 German insurance have reached agreements that allows them to pay for SPA treatments carried out in the Czech Republic.

Definition of cure therapy

The word cure is now used for only preventive and rehabilitative therapy. For therapy to be approved it must be medically necessary. The person should also be sick or disabled. Example, obesity, hypertension or post accident disorders.

Types of cure therapy

There are about 330 curative SPA operators in Germany.

Ambulante Vorsorgekur:

This is used for disorders at their onset.

Kompaktkur

Is a special ambulatory therapy used for specific types of diseases.

Stationaere Vorsorge +Rehabilitation:

Is a whole day treatment protocol designed to speed up the recovery period of the patient. Retirement insurance covers this therapy. It is carried out on in-patient basis.

Ambulante rehabilitation :

Rehabilitation therapy carried out in ambulatory setting. It is cheaper.

Anschlussheilbehandlung (AHB)

It is carried out after discharge from hospital to help the patient recover faster.

Only applicable to the disease that caused the hospitalization of the patient. The insurance is only valid for 14 days including the days that the patient spent in the hospital.

Müttergenesung:

Therapy for women who have raised or are raising children. Insurance companies are responsible for the expenses.

Vater-Kind-Kur:

Therapy for single parent fathers designed to protect and strengthen their physical and psychological health.

Kinderkuren:

Therapy for children with psychological and or physical disabilities. Health and retirement insurance covers the expenses.

Institutions responsible for paying the expenses of curative SPAs

Health insurance- For workers and people on retirement

Retirement insurance- For people with retirement insurance

Accident insurance- For therapy after an accident

Social institution- For people without any form of insurance

Jugendamt- For children and youth who have been taken from their parents and are under the care of the state.

Vesorgungsamt- For veterans and those who got wounded while on military duty.

Labor institute

Legal directive:

There are a number of legal directives to be fulfilled before the request for curative SPA therapy can be approved. The patient must have been insured for a specified period of time. He or she should not be older than 63 years. If the patient older than 63 years but is working or the disorder might improve upon treatment then therapy can be approved. Generally the right to curative SPA therapy terminates with retirement. Under this condition the health insurance have to meet the expenses of therapy. To qualify for a second therapy at least 4 years must have passed following the previous therapy. In emergency situations therapies can be approved earlier. Example, in chronic psorrhiasis therapy is approved only after one year.

In ambulant therapy all of physician services and 85% of expenses from use of materials are covered. Also, 13 Euros a day is paid for transport. Compact therapy is a form of ambulant treatment where a group of 15 patients are treated together. This is a fast and intensive form of treatment.

If ambulant therapy is not enough then in-patient therapy is used. The insurance pays all the expenses for in-patient treatment. Patient pays 10 Euros a day as contribution to therapy.

People who are younger than 18 years, low income earners, unemployed are exempted from this contribution.

Application procedure for curative SPA therapy.

The patient gets the right to curative SPA therapy if a doctor recommends it based on diagnosis. The procedure is facilitated if the physician stresses the emergency of the situation and states this in his or her prescription. The physician will also state the type of therapy required and give brief information on types of SPAs. Therapy is limited to 4 weeks. The patient then contacts the insurance company and fills out an application form. It is then decided whether expenses will be covered by health insurance or retirement insurance.

The need for curative SPA therapy is evaluated by an independent committee. The file of the patient is examined and it is then decided whether application should be approved or not. Form of payment is also determined according to the type of curative SPA, the severity of the disease and the patient’s income. In line with this either half of or all the expenses are covered by the insurance company.

Generally the expenses of active workers are covered by the retirement insurance while that of people on retirement are covered by the health insurance.

The patient, with the help of a physician and the insurance company chooses a SPA and the period of treatment is determined. The SPA doctor examines the patient and makes a treatment plan specific for the individual. This is valid for both ambulant and in-patient treatment.

Patients who are treated outside the country pays for the services from their own pocket and on return to Germany presents receipts of expenses to the insurance company to retrieve their money.