What is an example of a chronic illness

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The treatment of chronic diseases usually requires intensive care by doctors from various disciplines and other health care professionals, as well as the active participation of the patients.

Load limit for co-payments from insured persons with serious chronic illnesses

Insured persons with serious chronic illnesses are relieved of additional payments. You only have to make co-payments up to a limit of 1% of the gross annual income for living expenses. For all other insured persons, the load limit is 2%. The Federal Joint Committee determines in a guideline more details on the definition of a serious chronic illness. According to this, anyone who can prove at least one doctor's visit per quarter for the same illness for at least one year and also meets one of the following criteria: either need for care of degree 3, 4 or 5 or a degree of disability or a reduction in earning capacity is considered to be seriously chronically ill of at least 60%. In addition, anyone who needs continuous medical care is considered to be seriously chronically ill without which, according to the medical assessment, a life-threatening worsening of the disease, a reduction in life expectancy or a permanent impairment of the quality of life due to the health disorder caused by the disease can be expected. Chronic diseases that require ongoing treatment can include diabetes mellitus, asthma, chronic obstructive pulmonary disease, or coronary artery disease.

Structured treatment programs for the chronically ill (disease management programs)

Statutory health insurance companies offer structured treatment programs for certain chronic diseases - currently for diabetes mellitus (type 1 and type 2), breast cancer, coronary heart disease, bronchial asthma and chronic obstructive pulmonary disease (COPD). The Federal Joint Committee (G-BA) has the task of naming other chronic diseases for which structured treatment programs are being set up. It approved the requirements for a program for the treatment of chronic back pain on April 19, 2019, which came into force on October 1, 2019. The requirements for a program to treat depression were decided on August 15, 2019 and came into effect on January 1, 2020. In addition, the G-BA decided on a program for the treatment of osteoporosis on January 16, 2020. The health insurance companies are currently preparing the practical implementation of these new programs - as well as the programs for the treatment of chronic heart failure - in practical care.

The chronically ill can participate voluntarily in these so-called disease management programs (DMP).

In the programs, doctors from various disciplines and care sectors as well as other health professions work together in a coordinated manner. Together they treat patients using the latest methods, the effectiveness and safety of which have been scientifically tested.

Patients are regularly informed about diagnoses and therapeutic steps and are involved in treatment decisions from the outset. For this purpose, among other things, own training courses are offered. Together with the doctors, the insured persons agree on a therapy plan tailored to their needs, individual therapy goals and regular follow-up appointments.

The statutory health insurances must offer a corresponding optional tariff for insured persons who voluntarily enroll in such a structured treatment program and want to actively participate in it.

In the case of co-payments, the chronically ill who take part in a DMP are subject to a reduced limit of one percent of their gross income instead of the usual two percent.

Treatment programs for the chronically ill

Further structured treatment programs are being developed for the chronically ill. The Federal Joint Committee (G-BA) has received the mandate within the framework of the Supply Strengthening Act to name further chronic diseases and to issue guidelines for the design of programs for the treatment of back pain and depression. The requirements for a program for the treatment of chronic back pain were decided on April 19, 2019 and came into force on October 1, 2019. The requirements for a program to treat depression were decided on August 15, 2019 and came into effect on January 1, 2020. In addition, the G-BA decided on a program for the treatment of osteoporosis on January 16, 2020. The practical implementation in the care is currently being prepared by the health insurance companies.

The increase in multiple illnesses and chronic illnesses in our aging society also means a challenge for the further development of medical care. For this reason, an innovation fund with a funding volume of 300 million euros each year from 2016 to 2019 is being created to promote innovative, especially cross-sectoral forms of care and for health care research. This allows targeted projects to be funded that break new ground in care.

In addition, insured persons are now entitled to sickness benefit from the day on which the doctor determines that they are unable to work - and not from the following day. This closes a supply gap for insured persons who are regularly only unable to work for one working day because of the same illness (for example because of chemotherapy or a certain form of dialysis).

Further development of care for the chronically ill

Further structured treatment programs are being developed for the chronically ill. The Federal Joint Committee (G-BA) is currently developing another DMP for the treatment of rheumatoid arthritis as part of its mandate to name further chronic diseases and to issue guidelines for the design of the programs. He also regularly updates the content of the existing DMP.

The increase in multiple illnesses and chronic illnesses in our aging society also means a challenge for the further development of medical care. For this reason, an innovation fund with a funding volume of 300 million euros each year from 2016 to 2019 is being created to promote innovative, especially cross-sectoral forms of care and for health care research. This allows targeted projects to be funded that break new ground in care.

In addition, insured persons are now entitled to sickness benefit from the day on which the doctor determines that they are unable to work - and not from the following day. This closes a supply gap for insured persons who are regularly only unable to work for one working day because of the same illness (for example because of chemotherapy or a certain form of dialysis).