PKV and doctors argue about fees

PKV wants to save on doctors' fees

Reform of medical fees: Fee dispute between doctors and private health insurance is becoming more acute.

(10.12.2010) The dispute between the private health insurance (PKV) and the medical profession about the arrangement of the fee regulation comes to a head. During the PKV federation of the black-yellow federal government with the announced reform of the medical fee regulation (GOÄ) a „clause“ In order to be able to negotiate dental and medical services even outside of the state's GOÄ, the physicians vehemently oppose such a reorganization of the fee schedule. The PKV hopes for the „clause“ more competition among physicians and thus falling costs, but the medical profession fears a price dumping associated with corresponding revenue decreases.

PKV demand „clause“ in the fee schedule
Apparently inspired by the concessions that the Federal Health Minister Philipp Rösler (FDP) has prepared the way in the context of the health care reform, the private insurers go on the offensive and demand of the Federal Government not only a fundamental modernization of the GOÄ, which should bring more transparency in the fee regulations. They also demand the introduction of a „clause“, in order to be able to negotiate directly with the doctors and dentists for services or the costs incurred in the future.

In the case of doctors, this regularly proposed proposal for selective contracts meets with massive criticism. Both the German Medical Association (BÄK) and the German Society for Insured and Patients (DGVP) see in the „clause“ a „serious threat to medical and dental care“. On the other hand, the medical profession and the private health insurance company agree on the point that the fee regulations for the medical profession urgently need to be revised. For the GOÄ, which governs the fee payments for the respective medical services, has not been updated for decades. This results in an unmistakable discrepancy between the stipulated benefits or allowances and the medical-technical reality. Thus, many new innovative treatment methods are not even covered in the previous catalog of services. Therefore, the federal government from CDU / CSU and FDP wants next year to modernize the GOÄ tackle, which explain the current showdown between private health insurance and the medical profession a piece.

Doctors fear price dumping
The desired competition among the doctors would be „ruinous“, As the increased cost pressure would lead to decreasing quality of treatment, so the position of BÄK and Peter Engel, President of the Federal Dental Association (BZÄK), even speaks of one „Aldization of medicine“. In addition to the expected price dumping would be with the „clause“ Selective contracts also allowed the free choice of doctors and the freedom of therapy affect, so the fear of the medical profession. The doctors advocated a continuation of the current state fee regulations similar to their previous form, as they have a „protection“ for the doctors and patients. In any case, use the „clause“ the PKV only for patient control and to increase their own profits, so the position of the doctors.

PKV emphasize that „Achievements of contract freedom“
For private health insurance, however, the position of the doctors is incomprehensible. „The freedom of negotiation and the instrument of the contract are older than the German Social Security. They belong to the essence of our liberal society“, said Reinhold Schulte, CEO of Private Health Insurance Signal Iduna to the journal „pharmacy magazine“. Schulte criticizes that the physicians on the one hand always emphasize their freelance, with the „Achievement of contractual freedom“ but apparently do not know what to do. „You would rather prefer a centralized state-mandated top-up, instead of negotiating a transparent agreement yourself“, Schulte explained his view of the medical position. The doctors „are in effect advocating a ban on state negotiations. Nobody would have expected that from a liberal profession“, So moved on.

The medical profession fear cuts in the form of budgeting or capping of expenditure, according to the PKV Association are unfounded. Corresponding approaches are not in the concept of private health insurance to reform the fee regulation, but the private health insurance only wanted one „Improvements in quality” without rigid specifications that offer no possibility for deviation.

PKV hope for cost savings
That private insurers with the „clause“ also want to reduce their expenses in order to be more competitive and more sustainable, the PKV Association does not deny. Given the increase in expenditure on outpatient services between 2007 and 2009 by more than twelve percent, as well as similar increases in dental services, there is an urgent need for action from the point of view of private health insurance companies. The „clause“ should from the point of view of the private health insurance also not be a problem for the doctors, since even with the proposed adaptation of the GOÄ, the contracts between physicians and private health insurances can only be concluded by mutual agreement, ie to mutual satisfaction. However, the private insurers conceal that their bargaining position in the corresponding contracts should be far better than that of the medical profession. With their market power, they would certainly be able to significantly reduce the prices of medical services, which would not necessarily be to the benefit of the patients and certainly of detriment to the doctors. (Fp)