AOK Hospital Report For greed operations

AOK Hospital Report 2013: Spinal surgery often unnecessary

08/12/2012

The number of costly operations has increased significantly in recent years. This is proven by the hospital report 2013 of the AOK. While the hospitals see the cause in the increase of the older population as well as the medical progress, the health insurance companies accuse the hospitals to frequently put their economic interests in the foreground. In many cases expensive spinal column, knee, hip and heart operations are often unnecessary. Even before the official publication of the AOK 2013 Hospital Report, the clinics presented a counter-opinion, which comes to a very different verdict.

Many operations for economic reasons?
According to the AOK Hospital Report 2013, which was presented on Friday, costly spinal surgery and heart surgery in hundreds of thousands of patients are said to have been unnecessary. The Federal Association of AOK evaluated more than 45 million patient data from the years 2005 to 2011 and came to the conclusion that the clinics often their economic interests in the foreground. However, treatment with the latest surgical procedures is not always sensible.

According to the AOK report, the number of hospital stays has risen by 11.8 per cent per capita since 2005. Within 20 years (1991-2011), the number of in-patient treatments has increased by almost a quarter. 18.3 million clinic treatments were performed in 2010 alone. According to statistics, almost one in four Germans is operated on in a clinic. Striking is according to the hospital report, especially the increasing number of costly interventions. „Only a third of the increase was due to demographic trends and medical progress“, said Uwe Deh, board member of the AOK-Bundesverband.

Chief physician contracts criticized with surgery bonuses
Even the top association of health insurance had recently criticized German clinics, as many operations would be made without compelling medical reason. Particularly problematic are the bonuses for operations that are included in many chief physician contracts, which represent an additional financial incentive. Even the German Society for Surgery advises to push back these agreements from the contracts. According to a study by the management consultancy Kienbaum, almost half of the new chief physician contracts are now being supplemented with bonus payment agreements. This means that a head physician gets a generous supplement to his salary from his hospital if he achieves a specific goal, such as 30 percent more artificial knee joints.

According to a study carried out on behalf of the health insurance funds by the Rheinisch-Westfälisches Institut für Wirtschaftsforschung, the number is „orthopedic treatments have increased 14 percent in the last four years“. Cardiological interventions even increased by 17 percent. Almost two-thirds of the increase is not due to the increasing number of older people, according to the study.

Counter-opinion should justify an increase in operations
Immediately prior to the publication of the AOK 2013 Hospital Report, the Deutsche Krankenhausgesellschaft submitted a counter-opinion in order to refute allegations of unnecessary operations carried out purely for economic reasons. According to the study, although there was a significant increase in medical interventions, this was due to the fact that the number of older people is steadily increasing and the medicine has made great progress. „According to the survey of the German Hospital Institute according to the German Press Agency (dpa), a general defamation of the hospital staff and a groundless uncertainty of many patients is to be rejected. "There are thus undeniable economic disincentives, especially for the numerous surgeries But hip and knee joints as well as pacemakers and cardiac catheters would but it „solid indication“ give. These interventions would therefore not be arbitrarily ordered and performed by doctors.

According to the investigation is „the largest increase between 2007 and 2011 in circulatory and musculoskeletal system therapies“. 532,000 additional cases were registered, the „have been settled according to the standard procedure“. Overall, there is an increase in treatment cases „from 6.7 percent to 17.7 million a year“. Most patients (two out of three) would be referred to the clinics by general practitioners. The rest came as emergency in the clinics, so the hospital institute. There, not a doctor alone makes the decision about therapies and interventions, but it takes the multi-eyed principle. Whether so that the charge of the funds can be invalidated remains questionable.

Strong increase in heart and back surgeries
The 2013 AOK Hospital Report shows that pacemaker operations increased by a quarter between 2008 and 2010. For interventions in the back area, the number between 2005 and 2010 even more than doubled among AOK insured persons.

Striking are the regional differences. So are in Bavaria and Schleswig-Holstein „more than 50 percent more frequently performed back surgeries than in Berlin“. Karl-Walter Jauch, President of the German Society of Surgery, told the „Rheinische Post“, that there is a real competition between the clinics, especially in metropolitan areas like big cities. This would mean that patients would not be hospitalized for medical reasons alone.

The AOK report also analyzes the quality of treatment in the clinics. For this, complications and adverse events were compared in the 614 examined hospitals. Patients with catheters did not experience any problems in 74 hospitals, but in 34 hospitals the complication rate was 15%. Therefore, there should be the future opportunity for the coffers, „proven not to pay poor quality "so to speak „Uwe Dreh explained that around 1,600 clinics that treated AOK insured persons out of a total of around 2,000 German hospitals were included in the analysis. (sb)

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Picture: Martin Büdenbender