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Doctors newspaper online, 30.09.2019
Overview
For workers who have type 2 diabetes, a medical rehab may be advisable. But which of the payers is responsible – and what happens during the rehab?
By Thomas Hommel
© Robert Kneschke / stock.adobe.com (Iconic image with photo model)
BERLIN. Approximately seven million people in Germany are currently suffering from diabetes mellitus – the majority of them, about 90 percent, of type 2 diabetes. However, many do not know that these patients have the option of resorting to knowledgeable support in the form of a rehabilitation measure.
This has now been pointed out by the German Diabetes Association (DDG) and an overview of important questions and answers relating to the medical rehabilitation of type 2 diabetes and the corresponding application has been published. The instructions are interesting for patients as well as for treating GPs and specialists.
When a rehab is displayed
In the treatment of diabetes, the focus is on "help for self-help", emphasizes the DDG. Sufferers should be empowered to manage their condition so that their quality of life is not compromised. "However, if the metabolic control is inadequate in the long term, the earning capacity and independence of the patient are at risk", warns Privatdozent Dr. med. Erhard Siegel of the DDG. At the latest, a rehabilitation measure should be considered.
According to experts, poor metabolic settings with elevated HbA1c levels, frequent hypoglycaemia in the past and workplace-related problems in dealing with the disease are among the three "hard" criteria that justify urgent rehabilitation needs.
" If there are already accompanying or consequential diseases of the cardiovascular system or diabetes-related damage to the eyes, nerves or kidneys, the demand is all the higher", says Stephan Ohlf from the board of the Federal Association of Clinical Diabetes Facilities (BVKD). There are also other criteria that include lifestyle factors in addition to obesity, hypertension or depression.
Who is responsible for what?
In addition, after an acute treatment in the hospital there is the possibility of an accelerated application procedure in the context of a so-called follow-up treatment (AHB). "In this case, the application must be made by the acute hospital," explains Ohlf.
The Head of Administration of the Eleonoren Clinic of the German Pension Insurance Hesse adds: "Any acute care hospital treatment that is required by the diabetes disease is in itself an AHB indication." As a rule, the measure begins within 14 days after discharge of the Patients from inpatient treatment.
When applying for a rehabilitation measure, the attending physician is usually the first point of contact for the patient. "The doctor compiles a report that, among other things, justifies the needs and prospects of rehab," explains DDG expert Siegel. The doctor can then forward the application to the responsible payers.
For employed persons the pension insurance is responsible, for pensioners it is the statutory health insurance. According to the German Pension Insurance Association (Bund Deutscher Rentenversicherung), just over 10,000 medical rehabilitations were carried out last year alone for employees suffering from type 2 diabetes.
The aim of the rehabilitation benefits granted by the pension insurance is to "significantly improve or restore the significantly impaired or already impaired ability to work of their insured, or at least avert a deterioration," as a brochure of the German pension insurance association Bund
The statutory health insurance (GKV), in turn, finances medical rehabilitation benefits if it can "avert, eliminate, mitigate, mitigate or prevent an aggravation."
Since 2014, the expenditures of the health insurance funds for medical care and rehabilitation have largely remained at the same level – with a slight upward trend. Last year, they were around 3.55 billion euros, as can be seen from a fact sheet of the GKV-Spitzenverband.
Supply in the team
A medical rehab lasts at least three weeks. It can be done both inpatient and outpatient. In the choice of clinic for inpatient and outpatient rehab patients could also "bring their personal wishes," explains DDG expert Siegel.
A special feature of medical rehabilitation is the interdisciplinary approach to therapy, Siegel emphasizes: this is how the treatment takes place in a multidisciplinary team. In concrete terms, this means that doctors, nursing staff, psychologists, physiotherapists, diabetes counselors, dieticians and social workers work closely together here. "Many clinics can also treat other health problems such as those of the spine, hips or knees," says Siegel.
Enough time for training
Another special feature of rehab is the intensity of the treatment. "A rehabilitation program gives enough time to train patients in detail even with difficult problems, to familiarize them with new medications, techniques or lifestyle changes," says diabetes expert Siegel. Whether switching to pump therapy, exercise therapy, rapid weight loss, psychological support or clarification of diabetes-related professional problems – all these aspects could be sustainably treated with qualified professionals.
Rehabilitation: Involved in the Costs
Medical rehabilitation services are available on an inpatient as well as full-time outpatient basis. They usually last three weeks and can be shortened or extended as needed.
Costs for travel, accommodation, meals, care, therapeutic services and medical applications are borne by the competent pension insurance institution, provided that the employee makes the rehab application. The reimbursement costs of patients have to be included in a rehabilitation clinic if they are accommodated on site – at a maximum of ten euros a day for a maximum of 42 days a year. If patients have already claimed rehabilitation benefits in one year – also from the health insurance – all additional days will be taken into account. The additional payment also depends on the income situation.
Employees are entitled to salary continuation for the period of rehab. In general, this is six weeks. If the claim is wholly or partially consumed because of similar previous illness, those affected by the pension insurance can receive transitional allowance for the duration of the medical rehabilitation. ( eb )
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