Incentives in the health system are fundamentally wrong?

TK boss: The financial equalization disease is promoted instead of prevention
Many diseases could be avoided by a healthy lifestyle, but there are little incentives for the health insurance to promote healthy behavior of their insured, criticized the CEO of the Techniker Krankenkasse (TK), Dr. med. Jens Baas. The more illnesses a cash register can prove to its insured, the more money it receives from the health fund, according to the TK. The financial equalization promotes disease rather than prevention.

A large part of health spending in this country on the treatment of so-called diseases of civilization such as diabetes, cardiovascular disease and back problems, reports the TK. These are "often lifestyle-related and thus actually preventable - caused by unhealthy diet, lack of exercise and stress." But the incentives in the health system would be set wrong, because the financial compensation (the so-called Morbi -RSA) penalize funds, for example, if they take care of it that the diabetes of an insured person does not worsen, according to the TK.

Wrong incentives in the healthcare system: The more documented illnesses and prescribed medications, the more money for health insurance. (Image: Zerbor / fotolia.com)

The more sick, the more money
For the health insurance, the financial equalization makes it financially attractive to document as much illness as possible, explains the TK CEO. "The more illnesses are documented for our insureds and the more medicines they receive, the more money we get for them from the health fund," says Baas. The financial compensation honors the most dramatic documentation possible of disease, instead of promoting the competition for the best possible medical care and streamlined administration. "A health system in which no one has an interest in healthy people, is a sick system," complains the TC chief.

Commitment to prevention must be rewarded
According to the head of the TK, a nationwide commitment to health promotion is required to sustainably promote people's health and combat lifestyle diseases such as diabetes, heart disease and back pain. The necessary measures for prevention, however, cost money. Here it must be ensured that the commitment to a sustainable, healthier lifestyle is also rewarded. "But if we get less from the fund, the better it is for our policyholders, something goes wrong," Baas continues. The head of the TC therefore demanded that lifestyle-related illnesses, which could be avoided through prevention and a healthier lifestyle, no longer be overweighted in financial equalization.

Disincentives through the financial equalization
Already with the introduction of the financial compensation fears were expressed that this could create wrong incentives and in principle a particularly high proportion of diseased insured ones would be rewarded. Already "the first scientific advisory board of the Federal Insurance Office, which handles the financial equalization, had warned against the disproportionate consideration of these diseases and was in 2008, after he had been thwarted by the policy, resigned," reports the TK. "Today it shows: The Advisory Council was right," said Dr. Baas continues. (Fp)