Health insurance companies refuse billions demand

GKV top association rejects billions demand of the physicians

09/08/2012

The dispute between the statutory health insurance (GKV) and the doctors on an appropriate remuneration goes into the next round. On the basis of an opinion of the research institute Prognos, the GKV-Spitzenverband in Berlin rejected the physicians' demands for an increase in remuneration by around 3.5 billion euros and instead even brought down the benchmark for the remuneration for benefits.

On behalf of the GKV-Spitzenverband, the Prognos-Institut had compiled an appraisal that analyzes the revenue and expenditure development of physicians. The result: The revenues of the physicians have increased much more than the costs of the surgeries. The deputy chairman of the GKV-Spitzenverband, Johann-Magnus von Stackelberg, judged the „Demands of the medical profession for fee increases of well over three billion euros for 2013“ therefore as „completely covered.“

Compensation of doctors to adjust the effort
In the opinion of the deputy of the GKV-Spitzenverband, at the next round of negotiations on the remuneration of contract doctors at the end of August, the „Declining costs per service, a better utilization of the practices and other reserves of economic viability in the contract medical care on the negotiating table“- not only the „Prices and quantities“. The remuneration of the doctors should „in the future adapt to their effort again.“ The current report states that there has been a substantial increase in the surplus of medical practices since 2008.

Significantly increased revenue of doctors
According to the GKV-Spitzenverband, there is an increasing surplus at the doctors' offices, because a large part of their costs (for example, rents) are fixed and do not increase with the growing number of patients. The fixed costs „do not increase with the number of services provided, which, by the way, have increased far less than previously thought“, reports the GKV-Spitzenverband. Accordingly, the average surplus per doctor alone increased from € 105,000 in 2007 to € 134,000 in 2011 from the provision of statutory health insurance. Including revenues from the provision of privately insured persons, the net income per physician even rose to 165,000 euros in the same period, according to the Prognos Institute.

Prices for medical services should be corrected
According to research by the Prognos Institute, since 2008 doctors have received additional revenue of 3.2 billion euros. Keeping in mind the funds needed for additional services and increased costs as well as the savings from increased capacity utilization and organizational progress „The bottom line in this revenue-expenditure comparison is an overpayment to the doctors in the amount of almost 2.2 billion. Euro, which is reflected in rising surpluses“, so the message of the GKV-Spitzenverbandes. The project manager of the Prognos-Institut, Dr. med. Ronny Wölbing, explained that „If physicians are only to be paid for the actual cost increases and additional benefits, the price for the medical service will be corrected“ must. According to the calculations of his institute, the orientation value could be lowered by about seven percent.

Difficult negotiations between doctors and health insurance companies
The GKV-Spitzenverband wants „In the light of these facts, in the negotiations for the annual adjustment of the price component in the medical services of a contract, a reduction of the so-called orientation value from 3.5 to 3.25 cents for 2013 is requested.“ The responsible evaluation committee, formed from the contract partners of the Kassenärztliche Bundesvereinigung (KBV) and the GKV-Spitzenverband, is to set the orientation value for the coming year until 31 August. However, given the very different positions, timely agreement this year is expected to be extremely difficult. KBV is unlikely to be in favor of proposing a reduction in the benchmark, as the KBV chief executive, Andreas Köhler, said the 3.5 billion euros required are necessary to offset the increased operating costs and inflation since 2008. (Fp)

Image: Benjamin Klack