account for new technologies, changes in treatment patterns, and associated costs. Other payment systems like
pay-for-performance or bundled payments have yet to be implemented in hospitals.
Long-term care: LTCI is mandatory and usually provided by the same insurer as health insurance, and therefore
is composed of a similar public–private insurance mix. The contribution rate of 1.95 percent of gross salary is
shared between employers and employees; people without children pay an additional 0.25 percent. Everybody
with a physical or mental illness or disability (who has contributed for at least two years) can apply for benefits.
Eligible beneficiaries are stratified into three groups of care needs dependent on illness or disability severity. As
stated above, beneficiaries can choose between in-kind benefits and cash payments (around a quarter of LTCI
expenditure goes to these cash payments). Both home care and institutional care are provided almost exclusively
by private not-for-profit and for-profit providers. LTCI covers approximately 50 percent of institutionalized
care, and hospices and ambulatory palliative care are fully covered.
Mental health care: During the process of dehospitalization in the 1990s, acute psychiatric inpatient care was
largely shifted to psychiatric wards in general (acute) hospitals and the number of hospitals providing care only
for patients with psychiatric and/or neurological illness fell, while the number of office-based psychiatrists,
neurologists, and psychotherapists working in the ambulatory care sector (all funded by both SHI and VHI, and
paid FFS) increased. To further promote outpatient care for psychiatric patients (particularly in rural areas with
a low density of psychiatrists in ambulatory care), hospitals can be authorized to offer outpatient treatment.
Since 2000, ambulatory psychiatrists have been made coordinators of a new set of SHI-financed benefits called
“sociotherapeutic care” (which requires referral by a GP), to encourage the chronically mentally ill to use necessary
care and to avoid unnecessary hospitalizations.
account for new technologies, changes in treatment patterns, and associated costs. Other payment systems likepay-for-performance or bundled payments have yet to be implemented in hospitals.Long-term care: LTCI is mandatory and usually provided by the same insurer as health insurance, and thereforeis composed of a similar public–private insurance mix. The contribution rate of 1.95 percent of gross salary isshared between employers and employees; people without children pay an additional 0.25 percent. Everybodywith a physical or mental illness or disability (who has contributed for at least two years) can apply for benefits.Eligible beneficiaries are stratified into three groups of care needs dependent on illness or disability severity. Asstated above, beneficiaries can choose between in-kind benefits and cash payments (around a quarter of LTCIexpenditure goes to these cash payments). Both home care and institutional care are provided almost exclusivelyby private not-for-profit and for-profit providers. LTCI covers approximately 50 percent of institutionalizedcare, and hospices and ambulatory palliative care are fully covered.Mental health care: During the process of dehospitalization in the 1990s, acute psychiatric inpatient care waslargely shifted to psychiatric wards in general (acute) hospitals and the number of hospitals providing care onlyfor patients with psychiatric and/or neurological illness fell, while the number of office-based psychiatrists,neurologists, and psychotherapists working in the ambulatory care sector (all funded by both SHI and VHI, andpaid FFS) increased. To further promote outpatient care for psychiatric patients (particularly in rural areas witha low density of psychiatrists in ambulatory care), hospitals can be authorized to offer outpatient treatment.Since 2000, ambulatory psychiatrists have been made coordinators of a new set of SHI-financed benefits called“sociotherapeutic care” (which requires referral by a GP), to encourage the chronically mentally ill to use necessarycare and to avoid unnecessary hospitalizations.
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