Easier application for mother-child cures

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New guidelines for the approval and rejection of mother-child cures

In the future, plagued parents will find it easier to apply for a mother-child cure. In a joint statement by the National Association of Statutory Health Insurance Funds, the Bundesverband Deutscher Privatkliniken e.V. and the German Mothers Recovery Agency, the associations drew attention to the fact that the "Assessment Guideline Prevention and Rehabilitation" has now been completely revised after lengthy negotiations. The uniform guidelines also took emotional exhaustion or marital problems into account.

It is easier to apply for mother-child cures
In future it will be easier for mothers and fathers to apply for a mother or father-child cure from the statutory health insurance companies. All participating associations and institutions have agreed on a uniform regulation. In recent years, the savings efforts of the health insurance companies have led to a significant decrease in the mother-child cures that require a license. A decrease of 6 percent was registered in 2009 and a drop of 10 percent in 2010. In the first half of 2011, around 35 percent of all applications from afflicted parents were rejected.

Rejections were often arbitrary
The German government and the opposition have repeatedly criticized the fact that the rejections were “in many cases unfounded and therefore arbitrary.” The newly designed guideline is now intended to provide “transparency regarding the socio-medical recommendations and benefit decisions”, as the association of statutory health insurers emphasized. To make it easier for affected parents to request a cure with their children, criteria such as exhaustion, fears, constant time pressure, multiple stresses in work and family, and constant sleep disorders were also included. After all, health disorders cause a variety of physical and mental illnesses.

Doctor must consider cure as medically sensible
Since 2007, health insurance patients have been legally entitled to a joint treatment with their children if the family doctor has come to the conclusion that the measure is justified in the medical sense. However, the diagnosis as such is often not enough to actually start the cure. First, the health insurance company must give their consent. The applications were often rejected on the grounds that outpatient measures had to be initiated first, as the SPD member of the Bundestag Marlene Rupprecht reports. However, this principle does not exist with cures. In addition, many health insurance funds had not sent sufficient information on legal remedies with the rejection notices.

Federal government is satisfied
Are the innovations a guarantee that more cures will be approved? First of all, the guidelines, revised on behalf of the joint health committee and the Federal Ministry of Health, are a form so that rejections can be reasonably justified. In the opinion of the Minister of Health Daniel Bahr (FDP), the "revisions are a" noticeable improvement in the approval practice of the health insurance companies in the interests of the affected mothers and fathers ". The Federal Minister of Family Affairs Kristina Schröder (CDU) added that "sick and disease-threatened parents may have more hopes in the future that a needs-based application processing will be implemented".

All interviewees emphasize that all "scientific findings of the research network family health" were incorporated into the development. After all, the “talks had a good result” in order to achieve “needs-based application processing and care for families with health problems”. After the increase in the number of rejection notices in the past, it will become clear in the coming years whether the directive will not only bring more transparency, but whether more parents can use the offer. (sb)

Also read:
Better opportunities for mother-child cures
Mother-child cures at risk
Health insurers are approving fewer and fewer treatments
Frequent rejection of mother-child cures

Image: Lucie Kärcher / pixelio.de

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