Rehabilitation and pension institutions
The principle also applies to medical preventive and rehabilitation measures "outpatient in front of inpatient": Only when all possibilities of outpatient treatment including the supply of medicines, dressings, remedies and aids have been exhausted can inpatients be treated. The financing of inpatient provision and rehab services is also based on the principle "Rehabilitation before care"The measures must aim to maintain the self-reliance of the patient and avert or, at least, postpone the need for care, or to prevent their aggravation.
The Social Code V stipulates that patients can apply for inpatient rehabilitation or pensions only once every four years, unless previous treatment is necessary for medical reasons. The health insurance company decides on the grant of a rehabilitation measure according to its best judgment. A prerequisite is, inter alia, that a treatment success is to be expected. Before the treatment, the medical service of the health insurance therefore examines the treatment goal as well as the rehabilitation capacity and the need for rehabilitation. The benefits will be provided by a physician at the insured’s request and only after a medically justified prescription. In post-hospital rehabilitation after rehabilitation, the rehabilitation program will be initiated by the hospital as part of discharge management.
numbers, data, facts
- In 2014 there were 1,158 prevention or rehabilitation facilities with a bed capacity of 168,857.
- 54 per cent of all rehab clinics were run by private sponsors in 2015, around 26 per cent of the houses were in private hands, while public providers had the lowest share, at just under 20 per cent.
- Rehabilitation clinics employed around 89,521 full-time employees in 2014. Just over nine percent of them were medical staff.
- In 2014, nearly two million patients were treated in rehabilitation facilities.
- The average length of stay was 25.3 days.
No requirements planning for preventive and rehabilitation facilities
Pension and rehabilitation facilities are not covered by the hospital financing laws of the federal states. In contrast to the hospital sector, countries are therefore not responsible for an adequate supply of inpatient rehabilitation and pensions. Accordingly, the scope of services, the remuneration and the distribution of these facilities in the country are not determined by the state government.
The monistic financing of rehab clinics
For prevention and rehabilitation clinics, different funding rules apply than for hospitals. For example, institutions entrusted with inpatient medical care and rehabilitation are not entitled to contracts with social security institutions. Therefore, they can only bill their services with the health insurance companies if their providers conclude supply contracts. Basically, the funding of preventive and rehabilitation facilities "monistic": The operating and investment costs of the facilities must be covered by the remuneration for the services provided. In addition, the facilities include, among others, the health insurance funds, the German pension insurance, the employment agency and the statutory accident insurance. As a rule, the services are billed using indication-specific care rates, but case-by-case rates are also increasingly being agreed.
The copayment rules of rehab clinics
For pension and rehabilitation facilities, other co-payment rules apply. In the case of inpatient rehabilitation and pension benefits, adult insured persons pay a fee of ten euros per calendar day to the institution. The houses must forward the additional payments to the health insurance. In the case of follow-up rehabilitation after a hospital stay, the additional payment is limited to 28 days; additional payments already made in the hospital are taken into account.
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