Municipal medical care centres in Germany: perspectives on ownership and innovation in primary care

Background

Since 2015, German municipalities have been allowed to operate medical care centres with the aim of improving access to care, particularly in rural areas. Our study aims to examine the role and contributions of the approximately 50 municipalities currently providing basic medical care through these centres within a system where almost all outpatient care facilities are privately run by office-based physicians: What characterizes municipal ownership? What opportunities do these centres offer for innovation in primary health care?

Methods

Qualitative descriptive study. Semi-structured interviews with 18 stakeholders from public health administration, sickness funds, interest groups, and associations of municipalities at federal and regional levels; deductive–inductive content analysis.

Results

Stakeholders outline opportunities and barriers for municipalities striving towards ownership of medical care centres and partnerships in health care. They view the centres as a last resort to ensure basic medical care in rural communities where the traditional system is increasingly failing. The role of municipalities is currently limited due to an unclear mandate to provide outpatient care, lack of experience, and fiscal constraints. Regarding innovation, experts note that non-profit, community-oriented models are well positioned to integrate health and social needs; some associate the centres with attractive working conditions for professionals. While many see comprehensive primary health care centres as a desirable innovation, views diverge on the feasibility of transforming municipal centres accordingly. Despite promising practices, experts doubt that municipalities can realise this potential under present conditions.

Conclusions

Municipal medical care centres reflect growing municipal involvement in rural health care. However, their potential to evolve into comprehensive primary health care provision is limited and requires stronger health policy support.

Key messages

• Municipal ownership is a response to the shortage of private primary care practices.

• Involving municipalities as partners in outpatient care could strengthen health and social care integration.