Verfassungsrechtliche Ansprüche auf konkrete medizinische Leistungen

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Abstract: An insured person’s entitlement to statutory health insurance is limited to benefits that are necessary in the event of illness and economic benefits whose quality and effectiveness are generally recognised. Jurisprudence and legislators have developed numerous exceptions to this principle. This study examines in which cases such exceptions are constitutionally necessary and whether the existing exceptions in the SGB V (the fifth section of Germany’s social code) sufficiently reflect the constitutional right to concrete medical services. It provides a detailed overview of the areas of application in this respect and the prerequisites which allow the limits of statutory health insurance to be breached and their constitutional significance. As a result, unconstitutional gaps in care could arise in particular in cases of illnesses that are not directly life-threatening and courses of purely palliative treatment. The study also critically questions the constitutionality of the procedure used to decide whether a patient is entitled to benefits.