AOK criticizes certificates trading

GKV suggestion within the health insurance companies disputed

08/03/2012

The suggestion of the top federation of the legal health insurance companies (GKV) encounters within the cash group on strong criticism. The Federal Association had suggested so-called certificates for clinics issue, the less „unnecessary operations“ carry out. Cash registers that operate above the agreed limit should acquire certificates. According to the general local health insurance AOK Baden-Württemberg was the proposal „completely disabled“ and would lead to certificates trading.

The number of operations has increased massively in recent years. Health experts and health insurance companies suspect that often medical interventions are performed that would actually be unnecessary for the patient. As a result, the expenses of the funds have increased and in many cases, patients are unnecessarily burdened by the operations health.

AOK disagree about certificates model
The GKV-Spitzenverband now proposed to design a kind of certificate for hospitals in order to reduce the number of surgical interventions. Within the AOK this advance is however controversial. According to the treasurer of the AOK Baden-Württemberg is the proposal „unfit“. This would be another „Bureaucracy monster“ created. In addition, unnecessary interventions are hardly prevented so warned the cashier Christopher Hermann on Thursday in Stuttgart. The AOK Rheinland-Hamburg, by contrast, supports the GKV concept. According to the umbrella association, clinics that operate more than agreed could be required to obtain certificates from other clinics that were below the number of agreed procedures.

A study recently commissioned by the SHI showed that „the non-essential medical interventions between 2006 and 2010 by 13 percent“ increased. The health insurance companies therefore assume that clinics often force operations to increase the revenue side. The patients would be partially groundless „get under the knife“, although alternative treatments would yield a much higher benefit. To reduce the increase, experts have been looking for ways to reduce their numbers of operations for some time.

Clinic representatives refuse advance
Strong criticism of the certificate model came from the clinic representatives. The chairman of the German Hospital Society, Georg Baum, said the model was „complete nonsense“. According to his statements „Clinics no industrial companies“. Rather, it would after „medical necessity and treated under medical responsibility“. The health insurance companies would try with the push, „to ration the medical services of the hospitals“.

Legislation required to change the remuneration systems
The health expert of the CDU, Jens Spahn, called in the „ARD television“ legal regulations to curb the inflationary use of the scalpel. It could not work, „That doctors receive more money the more they operate“, criticized the politician in the broadcast. That can do it „wrong incentives for the surgeons“. The federal government should think about it, „to regulate or even prohibit such remuneration systems“, said Spahn.

Even in the ranks of the medical profession, the current remuneration model is controversial. Thus, the German Medical Association demanded to reform the currently valid remuneration system of the clinic. (Sb)

Also read:
Health insurance: Soon a federal AOK?

Picture credits: Lothar Wandtner