Germany


Original Editor - Crispin Danlag.

Top Contributors - Crispin Danlag, Didzis Rozenbergs and Elaine Lonnemann    


Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

  • Patients can freely choose and directly access both primary and secondary care providers since primary care physicians traditionally do not have a gatekeeper function. In this country, primary care includes all ambulatory care services provided by office-based, mostly single-handed, private for-profit general practitioners/family doctors, general internists or pediatricians. Approximately 49% of office-based physicians in Germany are primary care providers, and the other half are specialists—almost all specialties are offered in Germany by office-based secondary care providers.[1]

Therapist Preparation

      Degree/Credentialing
  • Approximately, there are 263 physiotherapy schools in the country graduating 7,000 students per year. Physiotherapy education has a minimum entry requirement at a level of 10 years' secondary school. Moreover, the physiotherapy education takes place at physiotherapy schools which are at a Polytechnic level. The physiotherapist education in Germany does not lead to the award of a university degree -as it is the case in most EU countries. Physiotherapy diploma however allows for postgraduates courses.[2] It takes three years to complete the PT program and is standard in all states in Germany. Once the program is completed, all PT students must pass a state examination (staaliche Prüfing). Students may receive three different certificates[3]:
  • a.) Bescheinigung certificate- the school issues this certificate to allow the student to take the examination.
    b.) Zeugnis or Abschlusszeugnis der Berufsfachschule (completion
    certificate of the Berufsfachschule)- confirms that the student has passed the state examination
    c.) Urkunde from state (Staat), or county (Kreis) or from district (Bezirk)- allows graduates to practice the profession
  • In Germany, all physiotherapists must be registered and obtain a license to practice. The "Ministry of Health" is responsible for the physiotherapy profession.[2] The physiotherapist must undergo a limited examination of his/her knowledge, in order to commence activities without a medical prescription.[4]
      Specialization
  • Physiotherapy specialists are recognized in Germany. There are possibilities for further qualification (e.g. Bobath, Vojta, PNF, Manuelle Therapie, Manuelle Lymphdrainage) which are recognized through the health insurances. In addition, physiotherapists are involved in both teaching and research.[2]

Professional Associations

Klein Physio-Deutschland-Lo.png

  • ZVK is the umbrella organization for approximately 31.000 members in 15 regional Physiotherapy branches in Germany, which represents nation-wide the political and professional interests of salaried physiotherapists and physiotherapists in private practice. Students can be associated members.[5]
  • The European Region of WCPT was established in September 1998, through the merger of the Standing Liaison Committee of Physiotherapists of the EU (SLCP), and the WCPT Europe (the Regional organisation of the World Confederation for Physical Therapy). The aims and objectives of the SLCP were to maintain the interest of physiotherapists in the European Union through different means.[2]

Information about the Patient Community

  • Germany has a population of 82 million in mid 2009.4 In medical research, there is an emphasis on the so-called zivilisationskrankheiten (diseases of the "civilized" lands), that is, heart disease and cancer. Heart disease caused 47 percent of all deaths in former West Germany and 52 percent of deaths in former East Germany as of 1997. In the same year, cancer was responsible for 25 percent of all deaths in former West Germany and 23 percent of deaths in former East Germany.[6]

Social/Cultural Influences

  • Typically, the father is the head of the family. Responsibility and achievement are still traditional values. Socialization on a casual rather than a formal basis is evident for boys and girls. Commonly, people live together before or instead of marriage. Legal marriages are performed and religious ceremonies are optional.[7] Germans have a reputation for being industrious, thrifty, and orderly.[8]
  • The parent/children relationships are usually somewhere in the middle spectrum authoritarian-democratic set-up. Husband/wife relationship is usually in equal partner arrangement.[9]

Delivery of Care

  • Although general practitioners have no formal gatekeeper function, a family physician care model was required in 2004, which provides a bonus for complying with gatekeeping rules. Physicians working in solo practices mainly deliver ambulatory care in all specialties. A mixture of fees per time period and per medical procedure pays for physicians in the outpatient sector. Individuals have free choice of ambulatory care physicians and, if referred to inpatient care, of hospitals.[10]

Type of Health System

  • The National Health Insurance in Germany is available to all citizens regardless of income, social status, and place of residence. Two pillars of the health service are solidarity and subsidiary. Under subsidiary is self-administration which consists of health insurance providers, health care professions, hospitals, and professional organizations. About 90% of Germans have national health insurance; 10% have private medical insurance. Services carried out by the physiotherapists and charged to the national health insurance providers are contained in the so-called cure and medicine guidelines.[4]

Payment System

  • Physiotherapists receive payment directly from the National Health Insurance provider. Social health insurance legislation only grants the right to direct access to physiotherapists in the context of prevention services.[4]

Resources

WCPT Country Profile for Germany

References

  1. Schlette S, Lisac M, Blum K. Integrated primary care in Germany: the road ahead. Int J Integr Care. 2009 Apr-Jun; 9: e14. Full version:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691944/?tool=pubmed. (accessed 8 Nov 2010).
  2. 2.0 2.1 2.2 2.3 ER-WCPT. Available from: http://www.physio-europe.org/index.php?action=15&subaction=details&member=26. (accessed 8 Nov 2010).
  3. Eftekari T. Towards a Better Understanding of the Physiotherapy Education and Practice in Germany. Available from:http://www.alliancept.org/pdfs/credential_news_physio_in_germany.pdf. (accessed 10 Nov 2010).
  4. 4.0 4.1 4.2 Direct access and Advanced Scope of Practice in Physical Therapy. Available from: http://directaccesssummit.com/notes/Boehle.pdf. (accessed 10 Nov 2010).
  5. ZVK. Available from: http://www.physio.de/zvk/quick.htm. ( accessed 10 Nov 2010).
  6. Germany. Available at: http://www.everyculture.com/Ge-It/Germany.html. (accessed 9 Nov 2010).
  7. Germany-Family. Available from: http://www.countryreports.org/people/family.aspx?countryid=91. (accessed 11 Nov 2010).
  8. Germany-Socializing. Available from: http://www.countryreports.org/people/visiting.aspx?Countryname=&countryId=91. (accessed 11 Nov 2010).
  9. Germany Family Dynamics. Available from: http://en.allexperts.com/q/Germany-141/2008/5/germany-family-dynamics.htm. (accessed 11 Nov 2010).
  10. Busse R. The German Health Care System. Available from: http://www.pnhp.org/PDF_files/LSE_Country_Profiles.pdf (accessed 10 Nov 2010).