Doctors are selling more and more benefits

Doctors are selling more and more benefits. The number of health services sold without taking over the health insurance has increased by 50 percent since 2005. The medical profession was able to generate revenues of around 1.5 billion euros per year.

08/12/2010

Many people are familiar with the phenomenon: As a patient, doctors are asking more and more frequently whether certain additional services for medical care or treatment should be provided. The special feature: The services offered must be paid out of pocket, as many benefits are not covered by the health insurance. This also applies, for example, to many treatments from naturopathy. Patients are often dependent on the statements of the doctors, who in turn often sell additional services in order to generate additional income. In fact, however, therapies are sold, which are very well taken over by the health insurance companies.

According to a study, physicians sell insured persons more often additional services such as ultrasound examinations, homeopathy or laboratory tests, which are not covered by the statutory health insurance. For physicians in private practice, these treatments generated additional revenue of around € 1.5 billion per annum, according to a study by the AOK Scientific Institute (WidO) on Wednesday. Since 2005, the proceeds from non-cash-based treatments and diagnostic procedures have increased by 50 percent.

Every fourth insured person (28.3 percent) has already been sold a health service that was not paid by the health insurance funds. The patients had to pay the costs out of their own pocket. About six years ago (2004), the share of additional benefits for health insurance patients was 16 percent. In 2001, even only nine percent. The most sold medical services were so-called Individual Health Services (IgeL) such as ultrasound and glaucoma screening at the ophthalmologist. Second place was followed by additional medicines, third place being remedies, e.g. from naturopathy and thereafter aids and precautionary measures such. Blood tests and laboratory services.

Not health but income decides on the claim
Around 2,500 patients took part in the survey of the AOK's health insurance fund. What was striking about the study results was that the individual additional benefits depended less on the patient's state of health or age, but rather on what level of education and what income the insured person had. According to that, people who take more than 4,000 euros net a month, in particular, take advantage of the additional services provided by a resident physician. Here, the rate of claiming the benefits was twice as high as those with less than 1000 euros net earnings per month. In this income group, only about one in six (16.9 percent) availed themselves of such health care without taking over cash. Patients with a correspondingly high income have already used one-third of their paid additional health care. Here, 38.8 percent of the participants stated that they had already had such experiences in a doctor's office.

Differences in the offer of non-insurable benefits were mainly in the individual specialists. For the most part, fee-based preventive services were offered to the ophthalmologist and gynecologist. Here, the additional benefits were sold up to seven times more than for example in general practitioners. In the other ranks, there are urologists, who offered patient offers in about five times, as well as general practitioners and dermatologists with an approximate fourfold offer.

Health insurance companies advise patients to be careful
The health insurance advise, however, to be careful. For some services, it is questionable whether additional benefits are even guaranteed. On the other hand, according to the general local health insurance AOK often health services are sold, which are actually considered standards and can be regularly charged by the doctors as a fee. This applies above all to necessary ultrasound examinations and skin cancer screening. A demand from the responsible health insurance company can provide certainty in advance. Again and again it happens that physicians invent additional sources of income due to the ignorance of patients, although certain preventive and therapies can be accounted for as a cash benefit. (Sb)

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AOK boss: problem with medical oversupply
Dispute between AOK and family doctors escalates

Picture: Paul Golla