Health insurance against payment in advance at the doctor

Health insurance against advance payment to the doctor: The CEO of the umbrella association of the statutory health insurance opposes the reimbursement of expenses for the insured. The model saves no costs, but promotes overspending. For doctors too, the model brings financial risks.

Doris Pfeiffer, chairman of the board of the German Association of Statutory Health Insurance, said in an interview with the Frankfurter Rundschau (FR) that she would be reimbursed for a doctor's visit by a legally insured person. Such a model would not save healthcare costs, but even lead to overspending.

The CEO of the umbrella association of statutory health insurance, Doris Pfeiffer, has spoken in an interview against the planned model of reimbursement. The Federal Minister of Health Philipp Rösler (FDP) plans to further expand the model. Statutory insured are similar to the private health insurance initially pay each doctor's visit from their own pocket. Only at the end of the year should the insured submit the costs to their health insurance. The Ministry of Health emphasizes that this provision should be voluntary. Above all, health insurance companies and consumer advocates warn of a newly emerging „Three-tier health“. Insured persons without reimbursement would most likely only depend on basic care.

Health insurance companies can negotiate tariffs and benefits
Pfeiffer reiterated that the current statutory health insurance system has numerous benefits in terms of limiting overspending. Because the health insurance companies could conclude direct contracts with the doctors and clinics. Thus Pfeiffer told the Frankfurter Rundschau: „The health insurances can thus directly influence quality and profitability and thus the costs. If the insured pay off with the doctor, as in private health insurance, the health insurance funds lose this opportunity for cost control.“

Model creates no transparency: Insured want health help
The Federal Ministry of Health, on the other hand, emphasizes that the new model would create transparency. The receipts allow patients to understand the costs of health care. This argument does not apply to the Kassen-Verbandschefin, since sick people do not want to negotiate treatment but expect a treatment that promotes health. So Pfeiffer said: „The doctor is the expert the patient has to rely on.“

Doctors would have to bear the risk themselves if patients do not pay their bill
Medical associations support the proposal of reimbursement. Patients would be more self-reliant. A new model of co-payment or reimbursement could address the problem of unlimited demand for medical outpatient health services. „Only then will it be possible to come down from the high number of doctor visits a year“, Kassenärzte boss Andreas Köhler argued recently. Unnecessary doctor visits could be avoided by the prepayment model. But for Pfeiffer these arguments are not surprising. She told the newspaper: „The doctors hope to avoid all control instruments. People in emergencies can of course be easier persuaded to pay unnecessary benefits, as the health insurance in negotiations at eye level.“ But for the doctors, the model could have negative consequences, after all, they must bear the sole risk if the treatment costs are not paid. They would eventually have to take care of it if patients can not pay their bills. „In this aspect, the legal insurance is a safe bank.“ so Pfeiffer opposite the FR.

Higher costs for the insured?
In this course, Doris Pfeiffer also warned against higher costs. By the billing with the health insurance inevitably also the costs for the administration rise, since the expenditure becomes clearly higher. After all, it is no coincidence that the administrative burden on private health insurance is about three times higher than for public health insurance funds. At the same time, a performance audit is missing. It could happen that the insured persons are faced with higher costs because it does not work without discounts. (sb, 06.10.2010)

Also read:
Doctors are in favor of reimbursement
Rösler plans payment in advance at the doctor's visit
Private health insurance: Worth a change?