Chronically ill by health fund

Increase in chronic diseases through health funds
Since the introduction of the health fund in 2008, chronic diseases in Germany have massively increased. Thus, the NDR magazine "Panorama" in his current program has devoted the issue more closely and comes to the conclusion that not health reasons but the financial interests of health insurance cause the massive increase in chronic diseases.

Financial incentives for chronic diseases
Critics have complained at the launch of the 2008 Health Fund that the financial incentives of the new money allocation mechanism are going in the wrong direction, as insurers will in future have a strong financial interest in a large number of chronically ill insureds. For the treatment of the chronically ill, they receive higher allocations from the health fund. As physicians are also entitled to higher reimbursements for the treatment of their patients, they use the margin of discretion in the report, according to the report „encoding“ the respective clinical picture. They tend to classify patients as chronically ill or severely chronically ill, suspected „panorama“.

Doctors use scope for coding
Basis of the „panorama“-Report is a document from the Federal Insurance Office (BVA) shows that the number of people with severe chronic diseases in Germany between 2007 and 2008 increased by 4.6 percent. Medically, this sudden increase can not be explained, the statements in the NDR report. According to the BVA, 23 disease groups even saw an increase of more than 10 percent, with the attention deficit syndrome increasing by 14 percent and the number of diabetic patients by 17 percent, for example. This exceptionally strong increase in exactly the disease that can be better remunerated, can be loud „panorama“ no coincidence. The Bremen health economist Prof. Gerd Glaeske also emphasizes to the reporters that there is an incentive to produce more diseases medically than are actually present. The TV magazine assumes that "there are not actually more patients, but that the numbers are the result of the new billing options." As a result of the morbidity-oriented risk structure compensation (Morbi-RSA) introduced with the health fund, insurers and physicians are using it „panorama“ all leeway to achieve the highest possible reimbursements. "The increases are due only to the Codierweise and not on the fact that here really the cases have increased," said Prof. Glaeske in the report.

Massive increase in chronic diseases
The BVA has defined in a catalog 80 clinical pictures for which health insurance funds can make higher claims. According to „panorama“ It is clear from the documents of the BVA that in 23 of these 80 diseases the percentage increase was in the double-digit range. For the treatment of patients with the corresponding diseases, a total of € 86 billion additional allocations are available to statutory insurers. Even if the coverage of „panorama“ as well as the statement of the top association of the legal health insurance: „The financial equalization is still in the development process, but of course must be tamper-proof "clearly indicate that not everything is going in the right direction, the Federal Ministry of Health adheres to the model, a spokesman for the Ministry denied „panorama“ any suspected links between the financial reimbursement and the increase in chronic diseases. Rather, the rise is mainly due to the better coding of diseases by the doctors, since they are now familiar with the procedure. The "basic evil" of the "incentive for sick-coding", also mentioned by the Bremen health economist Prof. Glaeske, is not recognized by the Ministry of Health.

Patients once again suffer
On the other hand, the opposition voices the first critical voices. Karl Lauterbach, health expert of the SPD criticized that physicians, the illnesses "at discretion" can be documented, a high incentive subject to colleagues with a "documentation contest" to deliver and lead as many patients as chronically ill. „Such a system invites fraud“, because the fee of the doctors is based on the Morbi-RSA. The fact that he himself has contributed to the development of the model in the introduction of the health fund under SPD Minister of Health Ulla Schmidt, Lauterbach, however, conceals. In any case, the patients are once again the victims. Because a wrong coding of the disease by the doctor, can have far-reaching consequences. Anyone who is diagnosed as being chronically ill for a mild problem may later experience problems with taking out insurance or entering certain occupations. Sometimes a wrong diagnosis can bring lifelong disadvantages, because „the files run through the entire system ", explained Karl Lauterbach (fp, 15.10.2010)