Five euros practice fee misses the point

Proposal by the health economists: Five euros practice fee per doctor visit has nothing in common with the actual goal of minimizing unnecessary expenses

04/13/2012

Health economists propose to levy in the future five euros practice fee per doctor visit. For this, the quarterly payments should be omitted. The real purpose, however, to prevent unnecessary visits to the doctor failed. The only thing left to do is to create new financing instruments for the health insurance funds.

As part of the health care reform, the quarterly payment of practice fees was introduced. Because Germany is the world leader in the number of doctor contacts worldwide, the fee should discourage unnecessary consultations. As a recent study shows, the actual goal is completely wrong. Today, the health insurance companies understand the practice fee as a pure additional source of financing and do not want to do without it anymore. Now, the quarterly payment in favor of a regular practice fee of five euros per doctor consultation will be omitted. Leading economists from the Gesellschaft für Gesundheitökonomie are campaigning for this and receive approval from the German government.

The proposal as such is not new. Already in 2002, the Union pleaded for a five-euro fee per doctor's visit. According to the then discussion, patients should pay about 10 percent of the treatment costs themselves, but at least pay five euros per doctor's contact. In the course of the health care reform 2004 a compromise was negotiated with the SPD. The result is the current model, in which cash patients have to pay 10 euros per quarter. This applies to general practitioner visits as well as specialist consultation, if there is no referral.

Ironically, in times of billions in surpluses in the health fund, the insured should be asked even more to pay. The meaning becomes clear only when one considers that the future will look less rosy. Health economists are already predicting a massive increase in health care spending. On the one hand, this is due to demographic change, because people in Germany are getting older and older, leading to an increase in age-related diseases such as diabetes, dementia, cardiovascular disorders and Alzheimer's. On the other hand, doctors and clinics are demanding more and more fee payments. Medical progress is also taking its toll, as treatment costs are becoming ever higher due to ever more complex treatment methods.

Accordingly, it is no longer about the actual purpose of preventing unnecessary doctor visits and to use the practice fees as a control element. The practice fee, which already pays the health insurance companies more than 2.0 billion euros each year in the coffers, is a pure financial instrument. Because the additional contributions are not sufficient, it should be the practice fee.

In the meantime, it has become clear that Germans generally do not go to the doctor frequently. According to a study of the central institute for the Kassenärztliche supply in Germany at the beginning of February approximately 50 per cent of all medical treatments go to the account of 16 per cent of the legally insured ones. On average, every case patient goes about 17 times a year to the home or specialist. If one subtracts the 16 percent, only 4 visits to the doctor remain per patient per year. Thus, the goal seems to provide incentives through additional payments to prevent unnecessary cash benefits, completely failed. In addition, most people, if they have a moderate to high income, have gotten used to the fee. Klaus Dieter Kleitze, family doctor in Hannover: „No patient gets upset about the fee, it is simply paid“. Only with the low-income households it comes often to dunning procedures and delays, so the family doctor.

An additional 2.4 billion euros will be added to the new practice fee, as the economists have calculated. That would be equivalent to 480 million visits to the doctor each year, in which patients would have to pay five euros each. According to the working group of the CDU / CSU and FDP, the new fee „unbureaucratic“ be collected by a „new survey procedure installed“ becomes.

This is by no means unbureaucratic, because after all, the doctors would again have to ensure that the fees are collected by the patients. „In addition to the already increased workload, this means an extended bureaucratic act“, the general practitioner complains. Therefore, it is best to simply abolish the practice fees and invest more money in prevention, so that insured persons are saved from unnecessary diseases and unnecessary medical contacts are avoided.

The victims of the additional fees anyway would be those who belong to the low-earners of this society. Thus demanded the chairman of the German union federation, Michael summer, „Instead, to guarantee a reasonable health care and not to punish those who need to go to the doctor“. As a counterproposal summer again leads the „solidary citizens' insurance“ on. A fairer distribution of burdens could create new sources of funding for health insurances, said Sommer. However, this would mean the abolition of private health insurance, whose lobby is deeply rooted in the circles of the governing parties. (Sb)

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