Format

Send to

Choose Destination
Z Evid Fortbild Qual Gesundhwes. 2015;109(8):552-9. doi: 10.1016/j.zefq.2015.10.004. Epub 2015 Nov 14.

[Regulations of sickness certification as a factor for increased health care utilization in Germany].

[Article in German]

Author information

1
Otto-von-Guericke-Universität Magdeburg, Institut für Allgemeinmedizin, Magdeburg, Deutschland; Charité-Universitätsmedizin Berlin, Institut für Allgemeinmedizin, Berlin, Deutschland. Electronic address: wolfram.herrmann@charite.de.
2
Otto-von-Guericke-Universität Magdeburg, Institut für Allgemeinmedizin, Magdeburg, Deutschland; Charité-Universitätsmedizin Berlin, Institut für Allgemeinmedizin, Berlin, Deutschland.
3
University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norwegen.

Abstract

BACKGROUND:

In Germany, utilization of ambulatory health care is high compared to other countries. Classical models of health care utilization cannot sufficiently explain these differences. The aim of this study was to explore relevant factors which can explain the higher health care utilization in Germany. In this article, we focus on regulations regarding sickness certification as a potential factor.

METHODS:

An explorative qualitative study design. We conducted episodic interviews with 20 patients in Germany and 20 patients in Norway and participant observation in four primary care practices each. Additionally, we conducted a context analysis of relevant health care system related factors which emerged during the study. Qualitative data analysis was done by thematic coding in the framework of grounded theory.

RESULTS:

The need for a sickness certificate was an important reason for encounter in Germany, especially regarding minor illnesses. Sickness certification is a societal topic. GPs play a double role regarding sickness certification, both as the patients' advocate and as an expert witness for social security services. In Norway, longer periods of self-administered sickness certification and more differentiated possibilities of sickness certification have been introduced successfully.

CONCLUSION:

Our results point to regulations regarding sickness certification as a relevant factor for higher health care utilization in Germany. In pilot studies, the effect of extended self-certification of sickness and part-time sickness certification should be further assessed.

KEYWORDS:

Arbeitsunfähigkeit; Deutschland; Germany; Inanspruchnahme; Norway; Norwegen; Qualitative Forschung; Sickness certification; general practice; hausärztliche Versorgung; health care utilization; qualitative research; sick note

PMID:
26704816
DOI:
10.1016/j.zefq.2015.10.004
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center