Prevention and rehabilitation (Statutory Health Insurance)
In terms of the Federal Ministry of Health:
Medical prevention is supposed to prevent diseases. Rehabilitation services are all medical services that prevent, eliminate, reduce or compensate a disability or need of care, that prevent their increase or mitigate their consequences.
Prevention
Insured persons receive comprehensive provision benefits. The aim is to remedy a decrease in health, which would probably lead to illness in the foreseeable future, to counteract a threat to the healthy development of a child as well as to avoid a need of care. Depending on the individual case, medical prevention includes either outpatient treatment and provision at the place of residence, outpatient treatment and provision in a recognized rehabilitation clinic or treatment and provision in an inpatient prevention facility.
Rehabilitation
The aim: to cope as effectively as possible in everyday life. The participation of patients threatened or impaired because of health reasons should be recovered, improved or prevented from becoming worse by rehabilitation medical care. The measures help to restore capability. The spectrum goes from massages and spas to targeted physiotherapy or ergotherapy to psychotherapeutic conversations. Also in case of a disease nowadays the prevention is part of the treatment concept. Beside earlier and regular medical treatment also a targeted nutrition or for example an individual coordinated movement therapy and appropriate relaxation exercises can have a positive effect on the disease process of sick persons. Thus, possible disease consequences, for example of a stroke, are often mitigated. Relapses, worsening of the overall condition and secondary diseases happen less often.
Outpatient and inpatient prevention services are usually a task of the statutory health insurance, while rehabilitation services are also a task of the pension insurance or the accident insurance.
The measures for prevention and rehabilitation are nowadays used as flexibly as possible to meet the patients' living situation. Two variants are possible:
Inpatient and partly inpatient rehabilitation
In case of an inpatient rehabilitation patients are not only treated in a facility, they also live there - care around the clock.
In case of a partly inpatient rehabilitation patients visit a rehabilitation facility close to home only during the therapy periods. The other time - especially evenings and weekends - they pass at home.
Outpatient rehabilitation
In the outpatient rehabilitation, a local rehabilitation center or a rehabilitation clinic, which is authorized from the Statutory Health Insurance, is visited daily. There the patients receive targeted measures from practitioners or therapists, which include medical, physiotherapeutic, psychotherapeutic and other services. The patients come to the facilities for treatment only. If this is not possible for the patient, the "rehabilitation also comes into the house" - that means, certain services of rehabilitation and provision can also be offered in the familiar environment of the patients by mobile rehabilitation teams.
Length of rehabilitation measures
Inpatient preventive and rehabilitation services usually take 3 weeks, outpatient rehabilitation services at the longest 20 days of treatment.
The regular duration of inpatient preventive and rehabilitation services for children under 14 years is four to six weeks. In case of justified medical necessity, a prolongation of the preventive or rehabilitation services can be requested.
Co-payments
All patients over the age of 18 years have to make co-payments. The following rules apply:
- co-payments of ten euro per day in case of inpatient prevention or rehabilitation
- The co-payment is limited to 28 days in case of follow-up rehabilitation. Here, paid hospital co-payments are already recognized.
- The personal co-payment limit is two percent of the gross income or one percent in case of serious chronic illness (chronically ill regulatin - "Chronikerregelung").
In case of outpatient preventive services in health resorts, the health insurance takes the costs for treatments performed by a health resort doctor including the prescribed pharmaceuticals. Also remedies including the so-called health resort specific remedies and measures for health promotion are paid.
The health insurance can grant a financial subsidy to the other costs, which arise in connection with the outpatient medical preventive services. If insured persons are older than 18 years, they have to pay co-payments, for example for remedies and pharmaceuticals.
Basically the general co-payment regulations apply. A complete exemption of co-payments is not possible. When persons insured have reached their maximum burden of co-payments - two percent of their gross income or one percent in case of serious chronic illness (so-called chronically ill regulation) - they will be exempted for the rest of the calendar year from all further co-payments.
Selected information about "Prevention and rehabilitation (Statutory Health Insurance)":
Tables:
- Courses of preventive treatment, persons insured in the SHI (starting from 2014)
- Rehabilitation measures, persons insured in the SHI (starting from 2014)
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