[Opportunities and challenges of health insurance funding of outpatient cancer counselling centers: Findings from a qualitative interview study with employees and providers].

Abstract

Since 2020, cancer counselling centers (CCC) are able to apply for partial funding from health insurance funds in accordance with the statutory regulation 'Outpatient cancer counselling' (§ 65e SGB V). The study examines changes in the CCCs as a result of the utilization of partial health insurance funding from the perspective of employees and of the providers of CCC.As part of a qualitative study, guided expert interviews were conducted with employees and providers of CCC and analyzed using content-structuring evaluation methods. We surveyed 138 provider organizations and 189 CCC, and interview partners were chosen in a randomized selection process. The size and region of the CCC were taken into account in order to reflect different structural and personnel requirements of the CCC. Interview topics included general expectations and concerns, changes resulting from funding and an initial assessment.Data was available from 35 interviews (23 CCC, 12 providers). The majority of CCC and their providers reported improvements in terms of staffing and services, including the continuation and expansion of care services, increased staff capacity, and the expansion of branches or the establishment of new ones. The quality of care has been improved through professional development of counsellors, extended supervision and more appropriate premises. This was perceived as an improvement in CCC in the health care system. However, it was criticized that although there is a greater sense of security, uncertainty remains because funding of CCC is limited to three years without a guarantee of continued funding, even if quality standards and cost-effectiveness are high. This has had a negative impact on staff and services. In addition, funding has focused on counselling in individual settings, which, in some cases, has led to a reduction in the variety of services offered, e. g. in-group settings.The funding of the CCC by the health insurance funds is largely viewed positively by the participants. It could be argued that this measure is an important step towards achieving the goal of securing sustainable, regular funding for outpatient cancer counselling included in the National Cancer Plan. It remains unclear whether the current funding structure will promote a nationwide network of needs-based, high-quality CCC and how the continued operation of high quality and economically viable CCC can be ensured.