Ensuring medical care in rural areas - new opportunities for municipalities and districts New opportunities for municipalities and districts

On July 23, 2015, the Act to Strengthen the Provision of Care in Statutory Health Insurance (SHI Care Strengthening Act) came into force. One of the aims of this law is to respond to the looming shortage of doctors in rural areas. The current finding here is that more and more practice owners are unable to find a successor and are having to close their practices. The law therefore contains incentives for doctors to set up in rural (underserved) areas. On the other hand, it creates opportunities for municipalities to set up medical care centers (MVZ) themselves and thus participate as a new "player" in outpatient medical care.

Since the Statutory Health Insurance Care Structure Act of 2011, municipalities have been able to operate their own facilities for the direct medical care of insured persons in justified exceptional cases if care could not be ensured in any other way (Section 105 (5) SGB V). However, a justified exceptional case requires a certain level of care shortage or a permanent lack of care. In addition, the approval of the Association of Statutory Health Insurance Physicians is required for the establishment of a municipal facility. The municipalities may only take action if the measures taken by the Association of Statutory Health Insurance Physicians to avert the shortage have been unsuccessful. The hurdles for the establishment of a municipal facility were therefore set very high by the legislator.

The Act to Strengthen Statutory Health Insurance (GKV-Versorgungsstärkungsgesetz) now expressly includes municipal providers in the group of founders of a medical care center. The explanatory memorandum to the Act states that this is intended to enable local authorities to actively influence and improve healthcare provision in the region. MVZs under municipal ownership should be able to be founded in any legal form under public law. "Conventional" MVZs can only be founded in the legal form of a partnership, a registered cooperative or a limited liability company. This expansion of the legal forms for municipal MVZs was only included in the law at the end of the legislative process and thus considerably expands the scope for municipal providers, especially in connection with the upcoming expansion of municipal business law in Baden-Württemberg. Incidentally, municipalities must meet the same requirements and licensing regulations that apply to other providers of MVZs. However, here too, the legislator has provided for simplifications that benefit all providers: The "multidisciplinary facility" criterion previously provided for in Section 95 (1) sentence 2 SGB V, according to which doctors from different medical specialties must work in the MVZ, will no longer apply once the SHI Care Structure Act comes into force. This means that so-called same-specialty MVZs will also be possible in future. This could be of particular benefit to municipalities in rural areas that would like to address the shortage of general practitioners, for example by setting up a "GP MVZ".

Date: 11. Aug 2015