Catch premiums in the health sector

Decide premiums on medical care?

05/22/2012

Many doctors collect premiums for transferring patients to certain clinics or colleagues, according to a recent study commissioned by the umbrella association of statutory health insurances. The "Catch premiums are no exception in the German health service, but common practice," the association commented on the study results in a recent press release.

Gernot Kiefer, the chairman of the umbrella association of the statutory health insurance (GKV), believes that the catch premiums have a considerable potential for corruption. If in doubt, premiums or benefits in kind decide "to which doctor, to which clinic or which aid provider patients are directed", so the announcement of the GKV-Spitzenverbandes on Tuesday.

Patient transfer for a fee?
On behalf of the GKV-Spitzenverband, researchers headed by Professor Kai Bussmann of the Economy & Crime Research Center of the Martin-Luther-University Halle-Wittenberg had taken a closer look at the premium payments to physicians. The study is based "on a self- and industry assessment of medical service providers to the knowledge and application of legal norms as well as the practice of targeted allocations," said the GKV-Spitzenverband in the press release "Study proves: allocations for pay no isolated cases - significant corruption potential". In Germany, "600 registered physicians, 180 senior employees of inpatient facilities (hospitals, rehabilitation and spa facilities and nursing homes) and 361 non-medical service providers (for example, pharmacies, medical supplies, hearing care professionals or orthopedic converters) were interviewed throughout Germany. The result is frightening: 14 percent of physicians said allocations for economic benefits were common, 35 percent at least partially so. A total of 20 percent stated that a corresponding approach to other physicians or performance is common. Catch premiums seem to be even more widespread in inpatient facilities, 24 per cent of whose representatives described payroll allocations as a common practice, and among non-medical care providers, who considered catch premiums to be normal at 46 per cent.

Catch premiums in health care is not uncommon
Of individual cases can be here in any case, the GKV-Spitzenverband criticized the distribution of the catch premiums in the health service. While accepting patient referral fees is actually prohibited, many physicians seem to disobey it. The board of the GKV-Spitzenverbandes, Gernot Kiefer, stressed that he was "sure that many service providers act correctly", but "if one sees by the self-assessment of the industry that every fifth doctor does not know the professional prohibitions and at the same time allocations for consideration is also a scandal. "In fact, the doctors' answers to the question of premium payments are not just a criticism. Because extrapolated, therefore, "more than 27,000 registered physicians already violate today against professional law," said the statement of the GKV-Spitzenverbandes. "If criminal law were applied here, it would be clear what high corruption potential exists in the German healthcare system," emphasized Gernot Kiefer.

Apply corruption criminal law to doctors
According to the study leader Professor Kai Bussmann, "the common practice of allocation remuneration perceived by the study participants lives in many cases on the fact that the discovery risk for the individual actor is relatively low and the disadvantages for the profession as well as the health system as a whole far." lack of controls and sanctions "to the fact that" allocations against pay appear as a low-risk trivial offense, "added Gernot pine. But the acceptance of fees for the referral of patients, according to the board of the GKV-Spitzenverband is far from a trivial offense, which is why "the statutory health insurance increasingly use the new social law options" in the future and want to withdraw the contract doctors even in an emergency, the approval. "Patients must be able to rely on doctors recommending a specific clinic or laboratory for medical reasons and not for monetary reasons," emphasized Gernot Kiefer, and demanded that "as a last resort, corruption criminal law should also be applied to doctors in private practice". (Fp)