Rösler plans payment in advance at the doctor's visit

Rösler plans payment in advance at the doctor's visit. Cash patients should in the future reimburse the cost of each visit to the doctor and have it reimbursed by the health insurance at the end of the year. Consumer advocates, on the other hand, are taking a storm and talking about introducing a "three-class model" in health insurance.

(30.09.2010) The Federal Minister of Health Philipp Rösler (FDP) is in favor of patients having to pay in advance each time a family doctor visits. The system would be similar to the private health insurance, only at the end of the year you can submit the medical bill to the health insurance and get back the money already paid, if the health service is considered a cash benefit. Consumer advocates raise the alarm and warn against one „Three-tier health“.

Statutory health insurance should pay according to the will of the Minister of Health future, the medical bill itself and only at the end of the year to submit to the health insurance. The concept is based strongly on that of the private health insurance, but without the exclusive health services of private patients. The discussion is not new and has been going on for a long time.

Consumer advocates warn against "three-class medicine"
The reason for the planned new regulation is obvious, because the Federal Ministry of Health hopes that the introduction of patient receipts will lead to far-reaching savings potential. Anyone who first has to pay the doctor's bill himself, may think twice whether he goes to the doctor. This should obviously be achieved that people less „unnecessary“ visit a doctor's office. Consumer advocates are also raising the alarm: "We are critical of this initiative and there is a risk that a three-tier medicine will develop," said Ilona Köster-Steinebach of the Federation of Consumer Organizations opposite the Hamburger Abendblatt newspaper. Steinebach fears that by such a regulation a „Three-tier health“ arises. Among the three groups would be the private patients, the cash patients with reimbursement and the „gwöhnlich“ legally insured, who receive a doctor's treatment as „in kind“ is paid by the health insurance.

Doctors are in favor of the reimbursement model and hope for higher fees
Many doctors, on the other hand, favor the model. They would be able to settle their fee bills in a timely manner and would not have to take care of the reimbursement as far as possible. Because the bill is paid either way, even if the health insurance later refuses to reimburse the insured the costs. For this reason, obviously supports the Federal Association of physicians in the advance of the Minister. „Anyone who sees in black and white what the treatment costs, is probably more aware of it. One thinks: Is every visit to a doctor meaningful? "Said the spokesman for the federal health insurance association Roland Stahl, opposite the Abendblatt, but the consumer advocate Köster warns at the same time: „The patient must not stay on top of the costs.“ The danger is too great that the coffers then no longer finance numerous benefits without further ado. The patients would then often have to negotiate in advance with the health insurance, whether the health services are taken. There is also the danger that the patients would be overwhelmed with it. Köster-Steinebach: The plans must not be in danger of keeping cash-patients sitting on their bills, even though they pay their health insurance contributions on a regular basis. In addition, a new fee schedule for doctors must be created to clarify.

Health insurance companies criticize the planned model
Also some public health insurance companies were skeptical of the plans. "Payment in advance means that the doctors are allowed to grasp the wallet of their patients, which we reject," said the spokesman for the Kassen-Spitzenverbandes, Florian Lanz. "The benefits in kind principle is a cornerstone of social health insurance: If sick people go to the doctor, they should not have to ask themselves whether their money is enough to be able to go in advance."

Clearly criticized the consumer center Thuringia on the model. After all, doctors can use the reimbursement model to settle costs according to the fee schedule for doctors (GOÄ) or dentists (GOZ). This results in higher fees than the non-cash benefit principle. However, many proponents of the model argue that the model would put the sick patient on a par with a privately insured person. However, according to statements of the consumer advocates this does not apply. For additional services that are not included in the catalog of benefits of health insurance, the health insurance companies do not reimburse the costs.

Consumer protection: Model saves no costs
Not even cost could save the new model, so the consumer advocate Köster-Steinebach. Because the reimbursement model could undermine all the ambitions of the Federal Minister of Health Philpp Röslers. The doctors see it as an advantage to be reimbursed the costs in full in the future. The newspaper's consumer protection expert said: "Doctors hope for a quick payment in full, but the Kassenärztliche Vereinungen will not reimburse the full amount due to budgeting, so what about the difference?" Because usually the attending physician does not receive all treatments in the full amount that he has provided. If such a reimbursement system were implemented, physicians would not have the problem, but patients would. This happens very quickly in the daily routine of treatment, for example, treatments of a gynecologist for which she is not qualified. But many treatments are understood in a context, so that such overlaps occur frequently. The health insurance companies, however, examine such events very closely and then pay less in case of doubt.

Consumer protection now fears that the pressure will then be passed on to the insured. Consumer advocate Köster-Steinebach warns that sick people prefer to accept higher medical bills instead of having to wait longer for a doctor's treatment.

The chairman of the Association of Consumer Organizations, Gerd Billen, however, suggests that patient receipts be issued after every visit to a doctor. With such a receipt, patients should be able to check exactly which services were performed by the attending physician. As a result, it is also possible to promote cost awareness among the patients without cash patients having to pay the bills themselves first.

Federal Health Minister: No one should be obliged to
The Federal Minister of Health Philipp Rösler appeased yesterday, no one should be forced to the model. "There will continue to be the principle of benefits in kind." Im implying, above all, more transparency in the statutory health insurance. He wants insured people to be able to choose which model to favor. However, Rösler does not consider that the „usually“ Insured similarly as now the cash patients could be disadvantaged compared to the private patients.

Sharp criticism of drug approval procedures
Otherwise, the Minister of Health has to accept numerous allegations. Because the changes in the approval of medicines come on all fronts on sharp criticism. So far, the Joint Federal Committee (G-BA) was able to exclude drugs from reimbursement by the health insurance companies. In the future, according to the will of the Minister, such a decision is only possible if the Federal Committee can clearly prove the inappropriateness of the remedy. The Barmer GEK chairman, Birgit Fischer, said: "In the reorganization of the pharmaceutical market, the Federal Government seems to confuse health policy with economic policy." First, Philipp Rösler had vowed to address the "price dictates of the pharmaceutical lobby". Now, however, independent drug experts are being thwarted because the burden of proof is reversed by the changes. Completely absurd is the draft law because it must now be proven that medicine is without medical benefit. At present, however, the pharmaceutical industry has had to demonstrate the benefits of a new drug. What makes it so interesting is that the basis of the bill was based on a report from a law firm created on behalf of the Association of Research-based Pharmaceutical Companies (VFA). „The fact that the Federal Joint Committee should determine the inappropriateness of a drug even for approval goes beyond the objective of a benefit assessment completely”, said Rainer Hess of the Joint Federal Committee. (Sb)

Also read:
Healthcare reform: Pharmalobby benefits again
Health insurance companies criticize restriction Wahltarife
Consumer advocate demands patient receipts

Picture credits: Andreas Morlok