Dispute between midwives and health insurance companies



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Health minister calls for compromise between health insurers and midwives

For months the midwives have been arguing with the statutory health insurance companies about an appropriate remuneration for their services. If there is no significant increase, the midwifery associations have warned that the profession of freelance obstetricians will end due to the enormously high contributions to professional liability insurance.

For the central association of statutory health insurers, this is an exaggerated description, especially since midwives were already offered a complete compensation for the increases in contributions to professional liability in the negotiations. Before today's round of negotiations again, the Federal Minister of Health Daniel Bahr (FDP) asked the parties to the conflict to finally find a compromise. It will be seen in the course of the day whether the dispute about the increase in remuneration and the contributions to professional liability insurance for obstetricians, which has been going on for months, can actually be settled.

Contributions to midwifery professional liability too high The premiums for midwives' professional liability insurance have risen steadily in recent years. According to the German Midwifery Association (DHV), many midwives had already given up on the core area of ​​their profession - obstetrics - in 2010, when the insurance contributions for obstetricians were raised from 2,370 euros to 3,689 euros. The increase in professional liability contributions to 4,200 euros planned from July would further intensify this trend, according to the DHV. The midwives have been unsuccessful for years against the massive increase in insurance costs. In the meantime, the fronts between the health insurance companies and the midwives have hardened to such an extent that an agreement hardly seems possible at today's round of negotiations. The Federal Minister of Health has therefore once again clearly emphasized that a compromise must finally be found.

Federal Minister of Health demands compromise In an interview with the “Süddeutsche Zeitung”, the Minister of Health indirectly referred to the statements of the Federal Chancellor, who had assured the midwives of their support. "The nationwide supply of midwifery services is not only important to me," says Bahr. In his opinion, the federal government has already "taken account of many demands made by midwives", so that now "health insurers and midwives are obliged to bring the negotiation process to a good end." For example, the federal government ensured that the cost increases are explicitly part of the negotiations for professional liability, explained Bahr. Overall, according to the Minister of Health, "all conditions were created" so that "fair negotiations can take place." Whether his appeal will help to find a compromise remains open for the time being.

Escalation of the dispute between midwives and health insurers The dispute between midwives and health insurers is primarily about raising fees and compensating for the massive increase in obstetricians' professional liability premiums. An offer from the health insurance companies is on the table that, according to the GKV umbrella association, includes a full compensation for the increase in premiums for obstetricians' professional indemnity insurance and amounts to an additional 1.3 million euros per year. In the opinion of the midwifery associations, however, this offer is not sufficient, they are demanding a total of four million euros. The parties to the conflict could not agree on a kind of mediation, initiated by the Federal Minister of Health. Instead, the dispute continues to worsen and, according to the National Association of Statutory Health Insurance Funds, the midwifery associations had in the end no longer even reacted to suggested dates by the health insurance companies. According to the midwifery associations, this refusal was the result of breaches of trust by the GKV umbrella association. Because this had passed on confidential information and arbitrarily consulted the German Association for Home Obstetrics (DFH), although this was not a professional association but a specialist association with membership numbers in the double-digit range. The professional association for home obstetrics was "not relevant in terms of professional policy in the past" and is still not relevant today, according to the current press release from the German Midwifery Association, the Federal Association of Freelance Midwives in Germany and the network of birthing centers. "We therefore ask the National Association of Statutory Health Insurance Funds to give up these tactical games and very much hope that the DFH will not be misused by the health insurance companies to goof around its own professional group," the midwifery associations write in an open letter.

Sustainable financing model required for the professional liability of midwives In their press release, the midwifery associations also vigorously contradict the statement that the health insurance companies would have been willing to fully compensate for the increases in premiums for professional liability. “If the GKV's offer to increase liability had offset the costs, we would have agreed to this. But in reality this is not exactly the case, ”said the associations. The calculation and remuneration model favored by the statutory health insurers does not prevent midwives from giving up their jobs. A different calculation method for midwife remuneration was therefore repeatedly submitted to the GKV umbrella association, "which does not cost more in total, but could prevent midwife dying," said the midwifery associations. To date, however, the health insurance companies "had not agreed to this sustainable financing model for liability costs."

Arbitration procedure between midwives and health insurance companies next step If no compromise is reached in today's negotiations, the next step will be an arbitration procedure in which the former Minister of Justice Herta Däubler-Gmelin (SPD) is intended as an arbitrator. The midwifery associations were very interested in "submitting this pressing issue to the arbitration board for decision." The Federal Minister of Health hopes, however, that today's negotiations will still bring an agreement and the arbitration procedure can thus be avoided. "I now expect health insurance companies and midwives to come to a conclusion," the Federal Minister of Health urged. (fp)

Read on:
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Warning of lack of midwives

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