Rösler plans to pay in advance when visiting the doctor

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Rösler plans to pay in advance when visiting the doctor. In the future, health insurance patients should reimburse the costs for each doctor's visit themselves and have them reimbursed by the health insurance companies at the end of the year. Consumer advocates, on the other hand, are storming and speak of the introduction of a "three-class model" in health insurance.

(30.09.2010) The Federal Minister of Health Philipp Rösler (FDP) advocates that patients should pay in advance every time they visit a family doctor. The system would be similar to that of private health insurance, only at the end of the year can you submit the doctor's bill to the health insurance company and get the money already paid back, provided that the health service is considered a health service. Consumer advocates raise the alarm and warn of a "three-class medicine".

According to the will of the Minister of Health, statutory health insurers should in future pay the medical bill themselves and only submit it to the health insurance company at the end of the year. The concept is strongly based on that of private health insurance, but without the exclusive health services of private patients. The discussion is not new and has been going on for a long time.

Consumer advocates warn of "three-class medicine" The reason for the planned new regulation is obvious, because the Federal Ministry of Health hopes to introduce far-reaching savings potential through the introduction of patient receipts. If you have to pay the doctor's bill yourself first, you might have to think twice about going to the doctor. Obviously, this is to ensure that people visit a doctor's office less “unnecessarily”. Consumer advocates are also raising the alarm: "We are critical of this initiative. There is a risk that three-tier medicine will develop," Ilona Köster-Steinebach from the Federal Association of Consumer Centers told the Hamburger Abendblatt. Steinebach fears that such a regulation will result in “three-class medicine”. The three groups would be private patients, health insurance patients with reimbursement of costs and "usually" insured persons who are paid for medical treatment as "in-kind" by the health insurance company.

Doctors are in favor of the cost reimbursement model and are hoping for higher fees
However, many doctors favor the model. They would be able to settle their fee invoices in a timely manner and would largely not have to worry about the reimbursement of costs. Because the bill is paid either way, even if the health insurer later refuses to reimburse the insured person. For this reason, the Federal Association of Statutory Health Insurance Physicians obviously supports the minister's initiative. “Anyone who sees in black and white what the treatment costs is probably more conscious of it. One thinks about it: Does every doctor's visit make sense? "Said the spokesman for the National Association of Statutory Health Insurance Physicians, Roland Stahl, to the Abendblatt newspaper. However, the consumer advocate Köster warns at the same time:" The patient must not be left at the expense. "The risk is too great that the health insurance companies would no longer be able to finance numerous services without further ado, and the patients would often have to negotiate with the health insurance company in advance to ensure that the health services would be taken over There must be no risk of plans leaving the health insurance patients on their bills, even though they regularly pay their health insurance contributions, and a new fee schedule for doctors must be created to make things clearer.

Health insurance companies criticize the planned model

Some statutory health insurance companies were also skeptical about the plans. "Prepayment means that doctors have access to their patients' wallets. We refuse to do so," said the spokesman for the National Association of Statutory Health Insurance Funds, Florian Lanz. "The benefit in kind principle is a cornerstone of social health insurance. When sick people go to the doctor, they shouldn't have to ask themselves whether their money is enough to be able to pay in advance."

The Thuringian consumer center expresses clear criticism of the model. Because doctors can use the reimbursement model to bill the costs according to the fee schedule for doctors (GOÄ) or dentists (GOZ). This incurs higher fees than the benefit in kind principle. However, many proponents of the model argue that the model would put the insured patient on a par with a privately insured. According to the consumer advocates, this is not the case. The insurers do not reimburse the costs for additional services that are not included in the health insurer's service catalog.

Consumer protection: model saves no costs
The new model could not even save costs, according to consumer advocate Köster-Steinebach. Because the reimbursement model could undermine all ambitions of the Federal Minister of Health Philpp Röslers. The doctors see this as an advantage of having the costs reimbursed in full in the future. The newspaper's consumer protection expert said: "The doctors are hoping for a quick payment in full. However, due to the budgeting of fees, the full amount will not be reimbursed by the statutory health insurance associations. What about the difference?" Because usually the treating doctor does not get all the treatments that he has provided in full. If such a reimbursement scheme were implemented, the doctors would not have the problem, but the patients would. This happens very quickly in everyday treatment, for example treatments by a gynecologist for whom she is not qualified are not reimbursed. However, many treatments are in a context, so such overlaps are common. However, the health insurance companies check such transactions very carefully and then pay less in cases of doubt.

Consumer protection now fears that the pressure will then be passed on to the insured. Consumer advocate Köster-Steinebach warns, but sick people prefer to accept increased medical bills instead of having to wait longer for medical treatment.

The chairman of the Federal Association of Consumer Centers, Gerd Billen, suggests that patient receipts be issued after each visit to the doctor. With such a receipt, patients should be able to check exactly which services were performed by the attending doctor. This also helps to raise patient awareness of the costs without having to pay the bills themselves first.

Federal Minister of Health: No one should be obliged to do so
The Federal Minister of Health Philipp Rösler appeased yesterday that nobody should be forced to the model. "The principle of benefits in kind will continue to exist in the future." Above all, it is about more transparency with the statutory health insurance companies. He wants the insured to be able to choose which model they prefer. Rösler does not consider, however, that the “ordinarily” insured, like now, the health insurance patients could be disadvantaged compared to the private patients.

Sharp criticism of drug approval processes
The Minister of Health has to put up with numerous accusations elsewhere. Because the changes in the approval of medicinal products meet with sharp criticism on all fronts. So far, the Federal Joint Committee (G-BA) has been able to exclude pharmaceuticals from reimbursement by health insurance companies. In the future, according to the Minister's will, such a decision will only be possible if the Federal Committee can clearly demonstrate the inappropriateness of the drug. The Barmer GEK chair, Birgit Fischer, said: "When it comes to reorganizing the pharmaceutical market, the federal government seems to be confusing health policy with economic policy." First of all, Philipp Rösler boasted of addressing the "price dictation of the pharmaceutical lobby". However, independent drug experts are now being slowed down because the burden of proof will be reversed by the changes. The draft law is completely absurd because it now has to be proven that medication is of no medical use. At the moment, however, the pharmaceutical industry has had to demonstrate the benefits of a new drug. It is piquant that the basis of the draft law was based on an expert opinion from a law firm that was created on behalf of the Association of Research Pharmaceutical Companies (VFA). "The fact that the Federal Joint Committee should determine the inappropriateness of a medication for approval already completely ignores the objective of a benefit assessment," explained Rainer Hess of the Federal Joint Committee. (sb)

Also read:
Healthcare reform: pharmaceutical lobby benefits again
Health insurance companies criticize the restriction of optional tariffs
Consumer advocates require patient receipts

Photo credit: Andreas Morlok / pixelio.de

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