Reimbursement of dietary counseling in Germany

Peer-reviewed | Manuscript received: August 31, 2016 | Revision accepted: April 18, 2017

Survey of selected statutory and private health insurance companies

Introduction

According to estimates by the Federal Ministry of Health, about one third of all health care costs arise from diseases that are directly or indirectly influenced by diet [1]. These include overweight, obesity, type 2 diabetes mellitus, hypertension, dyslipidemia and allergies. Also, various forms of cancer and chronic inflammatory processes are influenced by certain nutrients.

Dietary counseling plays an important role in prevention and therapy of all of these diseases. Therefore, both dietary counseling and dietary therapy are enshrined in numerous guidelines and recommendations of several specialist associations. Dietary therapy is the only possible form of therapy for diseases such as celiac disease or food intolerances.

Abstract

Dietary counseling and therapy are an integral part of numerous guidelines for the prevention and treatment of diet-related diseases, such as metabolic disorders. Regulations on the reimbursement of dietary counseling and therapy by statutory health insurance companies (SHI) are provided in § 20 and 43 of Volume V of the German Social Insurance Code (SGB V). There are hardly any legal requirements for private health insurance companies (PHI). This inconsistency leads to uncertainty among all parties involved. The aim of this study was to assess the requirements for reimbursement of dietary counseling services of 25 SHI and 10 PHI in an online survey.

Twelve SHI participated in the survey. Due to relatively clear legal requirements, it was possible to establish a broad consistency among the SHI regarding the implementation in the field of prevention. However, the reimbursement within the framework of the therapy is heterogeneously regulated and characterized by case-by-case decisions associated with a high bureaucratic effort. PHI are not legally obliged to prevention. Only one PHI responded to that issue via email. This PHI subsidizes both preventive dietary counseling and dietary therapy according to case-by-case assessment and also refers to benefits considered eligible for aid. There is an entitlement to services provided by a physician, regardless of his/her qualification.

Conclusion: Statutory insured persons are entitled to dietary counseling services. However, dietary therapy is subject to case-by-case decisions. The assumption of costs by PHI is unclear.

Keywords: dietary counseling, dietary therapy, reimbursement, health insurance companies

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