Die Bedeutung des Wunsch- und Wahlrechts des § 9 SGB IX für die medizinische Rehabilitation aus Sicht der Rehabilitanden

OBJECTIVES: Everyone applying for medical rehabilitation (and other benefits to support participation) has a "Wunsch- und Wahlrecht" (meaning the right to individual wishes and choice relative to assessments, services and institutions as well as to the various benefits) according to § 9 of Book 9 of the German Social Code (SGB 9) concerning every aspect of the implementation of these services. This study was aimed at exploring the wishes of rehabilitants, their attitudes towards and experiences with the various aspects of the "Wunsch- und Wahlrecht" as well as their criteria in choosing a rehabilitation centre.

METHODS: A total of 10 open guided focus groups were conducted with 71 male and female participants from 5 different indications and aged between 26 and 80 years. Transcripts were analyzed by means of a summary content analysis.

RESULTS: Persons applying for medical rehabilitation benefits did not as a rule get information about their "Wunsch- und Wahlrecht" during the application process. Applying for post-hospital rehabilitation often meant to be faced with an only allegedly existing choice ("pseudo Wunsch- und Wahlrecht"). The participants objected only rarely to this missing share in decision-making. Most of them did not care about their rights to choose a rehab centre if only the application for rehabilitation was allowed. Various arguments were brought forward against the "Wunsch- und Wahlrecht", especially insufficient information about and time for enforcement and implementation of the "Wunsch- und Wahlrecht". Despite an explicit stipulation in § 9 SGB 9, notices of approval rarely stated reasons for ignoring the wishes expressed by the applicants. Many participants had reflected only little about choosing a specific rehab centre when applying for rehabilitation. Accordingly, most of the participants had difficulties to mention possible selection criteria.

DISCUSSION: On the whole, applicants have Only little knowledge about the "Wunsch- und Wahlrecht". This complicates its implementation considerably. The preconditions for making informed and valid choices between different clinics are not given under these circumstances. Most interviewees do not attach much value to the "Wunsch- und Wahlrecht".

CONCLUSIONS: From a social law perspective, it should be demanded that rehab applicants have to get better information about their "Wunsch- und Wahlrecht" and that they must be empowered to decide on their choice based on objective and valid information. The active role in the rehabilitation process that should generally be demanded from rehabilitants, should also be encouraged and fostered in choosing a rehabilitation centre.