Health insurance companies want to restrict additional benefits

Health insurance companies want to limit additional hedgehog benefits

22/09/2011

The statutory health insurance funds want to limit the additional benefits for outpatient specialists and specialists in the future. These are so-called „individual health services (IGEL)“, ie diagnostic and health services that are not listed in the catalog of benefits of the funds. Patients have to pay special diagnostics out of their own pocket. An actual benefit is often not proven.

More and more frequently, patients are asked by their treating doctor if they want to use a hedgehog offer. Such additional benefits have increased rapidly in recent years. A study of the scientific institute of the AOK (WidO) came to the conclusion that already every fourth patient in Germany has already taken advantage of a medical health supplement. While the share was 9 percent in 2001, it has now risen to 28.3 percent today. It is debatable whether the health services sold are even useful and necessary from a medical point of view.

Gernot Kiefer, board member of the umbrella association of statutory health insurance criticized the increasing number. Because with the hedgehog offers „It is primarily about sales and profits of doctors and not medical help for the sick“, as he reminded in the Berliner Zeitung. In his view, individual health services are in the majority „useless and therefore superfluous“.

Katrin G. from Stendal, four months pregnant, reports on her last screening appointment with her gynecologist. After the first ultrasound examination, the gynecologist said she would have to pay for the extra baby ultrasound herself at the next regular check-up because the health insurance company only took on a certain number of checkups. „Of course, I want to make sure everything is alright with my child“. So Katrin G. paid the hedgehog performance. But how much ultrasound is really necessary? The health insurance companies say that only a total of three ultrasounds have to be performed. The diagnostic performance of the ultrasound examination should not be overestimated. Very few changes can be clearly detected during routine examination. But it is the fear that causes many expectant mothers to carry out further desire checkups for a fee.

Health insurance companies demand 24-hour periods for consent with hedgehog offers
„It contradicts the medical ethos to accuse ill people of questionable services“, criticized pine. Finally, a bar must be advanced. The Kassenverband demands that the patient be a 24-hour „consent embargo“ remain. Only then should the investigation be allowed to be carried out. However, if a patient asks his doctor specifically for a desired performance, the deadline should not apply. Physicians should also inform the insured in detail about advantages and disadvantages as well as alternative treatments. To substantiate this, there must be a treatment contract in the future, according to the Kassenspitzenverband. Gernot Kiefer called on the federal government to include the proposals in the law to strengthen patient rights.

The black and yellow government has not commented on this. It remains questionable whether the change requests find a place in the legislative process. Because it's about a lot of money: Since 2005, the turnover of hedgehog services has increased by 50 percent to 1.5 billion euros annually. Ultrasound scans (20 percent) and glaucoma screening (16 percent) were the most frequently sold. In addition to diagnostics but also non-reimbursable medicines, remedies and aids to 11 percent blood tests and laboratory services were sold to health insurance patients. (Sb)

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Picture: Paul Golla