The advance payment at the family doctor is a Mogelpackung

Mogelpackung Prepayment with the family doctor: Consumer centers, health insurance funds and social organizations speak out a warning of the cost traps for persons with statutory health insurance.

A deep grip in the pocket of the insured are the plans of the Federal Government to extend the reimbursement of health care. This is criticized by the Verbraucherzentrale Bundesverband (vzbv), the Sozialverband VdK Deutschland (VdK) and the executive committee of the AOK-Bundesverband. The organizations call on the federal government to abandon the planned change in legislation and to protect the consumer from this cost trap.

To increase transparency in the healthcare sector, the three associations are in favor of developing the patient receipt instrument. The patient receipt has been available on a voluntary basis since 2004. It shows the performance and costs of a treatment. Ulrike Mascher, President of the VdK Germany Social Association: "Reimbursement can lead to unpleasant surprises for insured persons if they spend a large part of their costs after treatment, so insured persons must also be warned against being billed by doctors for treatment The social association VdK generally advises insured persons to switch to reimbursement. "

The Federal Government's plans for reimbursement of costs mean that more legally insured patients should first pay for their doctor's visits and hospital stays themselves and then have the reimbursed amount reimbursed by their health insurance. What sounds so harmless at first glance, is on a closer look for consumers most momentous:

If the consumer decides to reimburse the costs, the doctor will charge each individual service according to the private medical fee schedule (GOÄ) at a rate of 2.3 times. This means that the doctor gets more than double the previous income. However, the health insurance fund may reimburse the patient for the reimbursement only if the reimbursement has been paid. This results in large differences of more than 50 percent, on which the consumer ultimately remains seated. AOK-Bundesverband Jürgen Graalmann, Deputy Chairman: "Reimbursement does not solve a single problem in the healthcare sector, it just means one thing - the patients have to pay, the doctors collect."

In comparison to the GKV, private health insurances are running away dramatically and have to charge their insured more and more premiums from year to year. One reason: Doctors treat private patients not only for health reasons, but also for income, at the expense of the insured. This development threatens with the reimbursement also the legally insured. What serious fi nancial consequences would affect the insured, is shown by an example:

A 68-year-old woman goes to the ophthalmologist with vision problems. There a glaucoma (Green Star) is diagnosed. Since she has opted for reimbursement, she receives a fee bill. This is 409 euros, because the doctor has settled according to GOÄ (2.3-fold rate). Your health insurance will take over 72 euros, so they have to pay for the difference of 337 euros itself.

The federal government plans to shorten the period for reimbursement from one year to three months. Doctors have an economic interest in patients opting for the prepayment model. It threatens a massive urge of patients in the reimbursement for a quarter initially, to be preferred when appointments in the doctor's office. Anyone who decides against this billing process, then has the disadvantage and must be prepared for some doctors on longer waiting times. There can hardly be any talk of the voluntarism that is being promoted by Federal Minister of Health Rösler. Payment in advance at the doctor then means priority for the full purse. Consumer Affairs Director Gerd Billen said: "Patients and physicians should know what treatment costs, and the appropriate instrument for this is patient satisfaction, not reimbursement, because the current benefit principle ensures quality and efficiency in the healthcare system."

Surveys have shown that, in contrast to those who are covered by statutory health insurance, privately insured persons are much more likely to feel that they are carrying out unnecessary examinations and treatments. This risk will increase significantly for consumers who choose reimbursement for medical care reimbursement. (pm, 22.10.2010)