Inclusion of hyperbaric oxygen therapy (HBO) in diabetic foot syndrome as a benefit in the German statutory health insurance

The Joint Federal Committee (G-BA) is mandated to decide on the coverage of services in the statutory health insurance (SHI) in Germany. Through structured assessment procedures, it decides whether a method or service should be included and under which conditions (i.e., for which indication and quality requirements) they can be performed in the inpatient and outpatient sector at the expense of the SHI.

Hyperbaric oxygen therapy (HBO) in diabetic foot syndrome has been subject to assessments by the G-BA and its predecessor organizations previously. In 2000, the treatment method was not recognized as a benefit in outpatient care. Since March 2008, it was excluded from the coverage, as an inpatient treatment, except for adjuvant treatment of severe cases of Wagner stage III and higher. In February 2014, the G-BA decided to open a new consultation procedure on HBO in diabetic foot syndrome for both hospital and outpatient care.

As a result of this evaluation, the G-BA decided to extend the services in relation to HBO at expense of the SHI. The complementary treatment of diabetic foot syndrome with HBO is now part of outpatient care. Consequently, the method will be added as a recognized examination and treatment methods in Annex 1 of the directive “Methods of the contract medical care” which includes all benefits in the outpatient SHI in Germany. For inpatient settings, HBO can now be applied for cases of Wagner stage II and higher.

This decision by the subcommittee of method evaluation was based on several studies that show that wounds that do not start to heal under standard therapy healed better with an additional HBO.

The diabetic foot syndrome is characterized by a poorly healing wound on the foot. About three percent of diabetics in Germany suffer from this secondary disease, which is associated with circulatory disorders and nerve damage. The Wagner-Armstrong classification is used to classify the severity of the syndrome. In Wagner stage II the wounds have penetrated to the level of tendons and joint capsules.

The decision by the G-BA is available in German here.

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