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Country/JA: Germany flag Germany
Action type: Legal framework

Problem: There is a high prevalence of psycho-social distress and mental health disorders in cancer patients. Therefore, comprehensive cancer care should include psycho-social and psycho-oncological support if needed. In the past, funding and concepts in the delivery of care for outpatient services have been heterogeneous in Germany.

Objective: Nation-wide access to psycho-oncology outpatient services for all cancer patients including their families and their social environment, based on mutually agreed quality standards and a sustainable level of funding. The services are tailored to the needs of cancer patients and their families (e.g. timely psychological/psychiatric support, advice on the availability of other relevant services complementing psycho-oncological care).

Key Contextual Factors

  • The German Cancer Society (at federal level and their 16 regional branches) and other key players initiated the setting-up of psycho-oncology community-based services several decades ago. This type of services was funded through different sources (e.g. donations, project funding). The quality and range of service was inconsistent as well.
  • The National Cancer Plan (that was initiated in 2008) put forward recommendations in line with the German National Guideline Psycho-oncology to address these issues.
  • The above guideline makes specific recommendations on the organization and structure of services as well as the qualification of service providers (multi-disciplinary teams).

Key Components/Steps

  • 2016-2018: Mapping of psycho-oncological care in Germany by University of Hamburg (expert analysis).
  • 2018-2020: Setting-up of a multi-disciplinary Expert Group (scientific societies, patient representatives, health care providers, statutory sickness funds), chaired by the Federal Ministry of Health, within the National Cancer Plan. The Expert Group discussed in detail the results of the above expert analysis of University of Hamburg as well as the National Guideline Psycho-oncology and additional scientific evidence.
  • 01/2020: The Expert Group of the National Cancer Plan published recommendations on quality assurance concepts and funding models for all community-based psycho-oncology services.
  • 01/01/2020: The legislative framework “Reform in Psychotherapy Training Act” came into force  regulating the funding of the out-patient psycho-oncology services. The law stipulated that the “National Association of Statutory Health Insurance Funds” provide an annual contribution of 21 mio Euro for the delivery of services, securing stable and sustainable funding (criteria for funding are conditional on fulfilling quality criteria developed by the National Association of Statutory Health Insurance Funds in line with the recommendations of the Expert Group published in 01/2020).
  • 20/07/2021: Increase of funding from 21 mio Euro to 42 mio Euro by way of a further legislative framework (“Further Development of Health Care Act”).

Main Impacts / Added Value

  • The law enables nation-wide equal access to high quality, standardized community-based psycho-oncological care in Germany. Consequently, at the individual level there is an improved quality of life, self-efficacy, resilience, and potentially better outcomes in cancer progression and survival are expected.

Lessons Learned

  • Involvement of all stakeholders (scientific community, patients, political decision makers) and levels of decision making within and beyond the National Cancer Plan is paramount for effective legislation, generating a sense of responsibility for the issues and implementing programmatic health policy.