Versorgungsvertrag

Versorgungsvertrag is a contractual instrument within the German health care system that regulates the provision of medical services to insured persons under statutory health insurance (GKV). Such contracts are typically concluded between providers—such as the Kassenärztliche Vereinigungen (regional physician associations), contract physicians and other care providers—and the health insurance funds or their associations. They can also be concluded between regional physician associations and insurers for specific areas of care or integrated care arrangements.

Legal basis and purpose: Versorgungsverträge are regulated by the Sozialgesetzbuch Fünftes Buch (SGB V). Their main purpose is to secure a timely, adequate and high-quality supply of medical services, ensure regional accessibility and define the framework for how services are delivered, coordinated and paid. They may cover outpatient care, services within hospital settings in certain cases, and integrated care concepts.

Contents: Typical contract elements include the scope of services to be provided, remuneration and billing rules, patient access and freedom of choice within the contract, care coordination and referral procedures, quality requirements and performance indicators, data collection and reporting obligations, and terms for modification or termination of the contract.

Process and forms: Versorgungsverträge are usually negotiated at regional levels and may exist as Rahmenverträge (framework contracts) that set general terms, complemented by Einzelverträge (individual contracts) for specific services, regions or groups. They can incorporate elements such as disease management programs and integrated care agreements. Disputes are generally handled through established arbitration or supervisory processes within the statutory health insurance system.

Impact: The contracts aim to standardize care, control costs and ensure patient access to necessary services while defining the responsibilities of providers and insurers.