Key points for primary care in Germany: AOK presents proposals for strengthening outpatient care
17.07.2025 14:50
In the ongoing debate about shortcomings in the system's governance and the disadvantages faced by patients with statutory health insurance (GKV) when scheduling appointments at doctors' offices, the AOK Federal Association presented the concept paper "Well Cared For From the Start: Key Points for Primary Care in Germany" on July 16. The AOK proposes two instruments to ensure needs-based access to care for patients and greater efficiency within the system through targeted governance.
Firstly, the existing primary care system should be made more reliable and further developed into a team-based primary care system. Secondly, a rapid initial assessment of specific needs and urgency should be introduced as a new control mechanism, so that patient concerns can be referred more effectively to the appropriate levels of care.
This initial assessment should be possible in primary care practices and, as a supplementary service, at the central dispatch centers/appointment service centers of the statutory health insurance physicians' associations. The policy paper thus contains concrete proposals for establishing the mandatory primary care physician system stipulated in the coalition agreement. "The core element of our concept is primary care practices as an easily accessible and reliable point of contact for patients," explains Dr. Carola Reimann, Chair of the Board of the AOK Federal Association. There, teams of physicians, nurses, physician assistants, and other healthcare professionals will provide comprehensive basic care and, if necessary, guide patients further through the system. "We need stable basic care so that the population does not lose confidence in its healthcare system. The team-based structure of the current primary care model is an important prerequisite for this. The integration of telemedicine services is also more feasible in these teams than in individual practices."„
Patients should continue to be free to choose both primary care providers and specialists, but the AOK (a major German health insurance provider) stipulates that access to specialist care will only be granted after a qualified referral. "In light of long waiting times for appointments and the outpatient care goals of the hospital reform, specialist care must also be aligned with demand," said Reimann. Exceptions to the referral requirement will apply to pediatricians, gynecologists, and patients with chronic illnesses, as well as for preventive health screenings. Furthermore, to ensure that those with statutory health insurance receive appointments with specialists more quickly, out-of-pocket services will only be permitted during designated consultation hours.
According to the AOK concept, the Federal Joint Committee (G-BA) should define minimum standards for a new service mandate to transform the existing general practitioner care system into a comprehensive primary care system. This mandate would then form the basis for outpatient needs planning. Vacant general practitioner positions should then be filled exclusively according to the new requirements of this service mandate, while transitional arrangements are called for for existing practices.
Quick orientation through a standardized initial assessment procedure
In addition to primary care providers, the AOK (a German health insurance company) also sees the central dispatch centers located at the Associations of Statutory Health Insurance Physicians as another system interface. Alongside primary care, these centers are to assess the urgency of treatment using a standardized initial assessment procedure and also refer patients to the appropriate care. Reimann: "With this, we are also adopting the plans from the emergency care reform and integrating the pathways through the various care services." Looking ahead, a sector-independent, regional outpatient care plan is needed, in which the capacities of primary care, specialist primary and specialized care, outpatient surgery, and the outpatient services provided by hospitals are planned comprehensively.
Implementation in standard care with regional flexibility
The further development of healthcare provision mandates will establish nationwide minimum standards. "However, given the very different conditions in metropolitan areas and rural regions, regional flexibility must be allowed," said Reimann. The existing obligation for health insurance funds to offer primary care-centered services (PCS) will be abolished, but will remain possible regionally on a voluntary basis.