The medical association sees self-destruction of PKV

The vice president of the medical association sees „Self-destruction“ Private Health Insurance (PKV)

12/13/2010

Rising health care expenditures are also increasingly affecting private health insurance companies (PKV). In order not to have to increase the contributions, the private insurers are increasingly trying to limit the escalating costs. They were backed by the black-yellow federal government and in particular by the Federal Minister of Health Philipp Rösler (FDP). As part of the healthcare reform, PKV has made numerous concessions that will strengthen its competitive position in the future. But with the concessions in the direction of the PKV also the criticism of the additional demands of private health insurance is growing.

The simplified change between the statutory health insurance (SHI) and the PKV, the prohibition of supplementary insurances in the SHI and the extension of the drug rebate are examples from the health care reform, which significantly strengthen the position of the PKV - often at the expense of the SHI. And so in the professional world, the criticism. In view of the current power measurement between the private health insurance and the medical profession on the revision of the fee schedule, Frank Ulrich Montgomery, Vice President of the German Medical Association, took the opportunity and in a guest contribution for the magazine “insurance industry” (22/2010) accused private health insurers and the private health insurance association „impressive spectacle of self-destruction” to offer. The demands of the private health insurance would come one „GKV-ization“ equal and would in case of success be the death knell for private insurers, said the representative of the medical profession.

While lower costs, higher benefits, and better service have always been used as arguments in favor of private health insurance, Frank Ulrich Montgomery can no longer follow this argument. The Vice President of the German Medical Association explained that the lower costs can no longer be used as an argument, if the private health insurance now constantly because of the cost explosion for perks similar to those of the GKV demands. A better service would indeed receive the private patients, but primarily because the private health insurance have agreed with the doctors higher billing rates than the GKV. This contractual freedom offers a decisive advantage over the GKV, explained Frank Ulrich Montgomery. Doctors at private patients, thanks to the fee scale, earn more money, even with identical performance, and are therefore ready to provide a better service. If this fee regulation is now aimed at by the PKV „clause“ infiltrated and the comfort tariffs are canceled in order to save costs, the question arises: „With what justification does the PKV expect even faster and more convenient service?”, Montgomery explained. At the end of his article, the Vice President of the German Medical Association points out that he does not ignore the fact that for many insured the private health insurance with the fast appointment and the separate waiting room „Feel-good product“ be. However, in his view, there is no reason to regulate this via the detour of a different payment according to fee schedule.

This also makes clear what Montgomery is all about: that aimed at by private health insurance „clause“ in the reform of the medical fee schedule (GOÄ) for the billing of medical services in the coming year. While the private health service wants to have the opportunity to negotiate with the doctors individually about the benefits and the associated costs, the doctors resist massively against such a softening of the existing GOÄ. With the allegations now voiced, the showdown in the run-up to the reform is now entering the second round. The PKV had already accused the medical profession last week, „de facto for a state ban on negotiations“ to use what „no one expected from an outdoors profession“ would have. The tone in the discussion becomes rougher, the contents shallower. It remains to be seen how the Federal Government will decide on the urgently needed reform of the GOÄ in the coming year. (Fp)

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Picture: Gerd Altmann / Gerold Meiners