Structural change in outpatient care in Germany: An empirical study of patient preferences between individual practices, group practices and medical care centers

Background The German healthcare system is confronted with structural changes in the outpatient sector. In addition to individual practices, the setting is also characterized by professional practice groups and medical care centers. Overall, there is a trend in Germany towards outpatient care and cooperative care structures that address the increasing medical needs and changing working conditions. The article begins by explaining how the healthcare system in Germany is structured. This is followed by a detailed discussion of possible forms of cooperation in statutory health insurance practices. Methods The aim of the empirical study is to identify the key factors influencing the choice of practice type in outpatient contract medical care. The focus is particularly on the variables of age, place of residence, source of recommendation, patient satisfaction as well as the severity of the illness. As part of a quantitative data collection via a random sample, various participants (n = 1,010) were surveyed online about the outpatient care structure of statutory health insurance physicians in Germany. From this, the significance between patients or patient group and form of practice can be statistically determined using a chi-square independence test. A possible effect size is calculated using Cramer's V. Results The correlation between age group and form of practice was not significant (χ² = 4.24; p = 0.8948), nor between place of residence and form of practice (χ² = 3.42; p = 0.3311). In contrast, there was a significant but weak correlation between the recommendation rate and form of practice (χ² = 42.49; p < 0.001; V = 0.118). There was also a significant but small effect between form of practice and patient satisfaction (χ² = 34.95; p = 0.0025; V = 0.107). For severe illness, there was a clear preference for MVZs (χ² = 84.25; p < 0.001; V = 0.29). Conclusions The results show that there are various factors on which the choice of practice form depends. At the same time, there is a clear trend in the outpatient sector: the number of individual practices is decreasing, professional practice groups remain constant and medical care centers are increasing. Nevertheless, a regulated organization of the outpatient care landscape is needed, especially against the background of ambulantization. JEL codes: I19, I11, I13