Austerity course of health insurance to the detriment of patients

Hundreds of thousands of patients are rejected for desired services

08/19/2013

The statutory health insurance apparently pursue a stricter austerity program and deny the insured more and more often certain benefits. Hundreds of thousands of health insured persons would have received from their insurance in 2012 a negative decision on benefits such as rehabilitation measures, aids or sick pay, reports the news agency „dpa“ citing current figures from the Medical Service of the Health Insurance (MDK).

Although most statutory health insurance funds are currently relatively well financially, the memory of the bankruptcy of several health insurance companies just over two years ago has not yet faded in most. A significant role in the then insolvency of the City BKK and other health insurance companies played the additional contributions. The beleaguered coffers had to raise these to catch their financial imbalance. However, the collection of additional contributions meant that many insured persons changed to another health insurance without additional contributions. In particular, young, healthy and relatively well-off insured were lost to the health insurance and the expenditure structure continued to deteriorate. In the end, sometimes only the way to bankruptcy. Since then, the primary objective of the health insurance companies has been to avoid levying additional contributions, since otherwise a similarly fatal development is feared.

Austerity course to avoid additional contributions
Since then, many health insurances have been driving a stricter austerity program in order to avoid having to make additional contributions. Benefits for insured persons would be more strictly controlled and often not granted, reports the news agency „dpa“. In 2012, the legally insured had received hundreds of thousands of negative opinions on requested services. For example, about 1.5 million reports from the health insurance funds have been requested from the health insurance funds on medical incapacity for work, with 16 per cent of cases denied incapacity for work. In other words, more than 200,000 people who were initially declared incapacitated by their doctor were, according to the MDK, able to continue working. In the rehabilitation measures reviewed by the MDK, the proportion of negative decisions was even higher. Of the 700,000 rehabilitation benefits reviewed, only 61 percent were confirmed as necessary by the MDK. In 39 percent of the cases, the experts did not meet the medical requirements. Two out of five people hoping for a rehab did not receive it. In the case of hearing aids, the proportion of cases not approved was that of the „dpa“ similar high. 500,000 MDK reports have been prepared in this area, followed by a negative decision in 37 percent of cases.

Well justified refusal of requested services?
The managing director of the medical service of the top federation federation of the health insurance companies, Dr. med. Peter Pick, has rejected the criticism of a supposedly tougher austerity program of the health insurance and made it clear that the reviewed cases of inability to work, rehab measures and approved aids since 2010, actually a slight decrease was observed. He also pointed out that it could be quite useful to reintegrate people with mental health problems into the world of work instead of declaring them incapable of work. Although the aids had a high rejection rate, this did not mean that those affected remained unprovided. Because they would often receive instead of the services originally provided another care, which also fulfills its purpose. Despite the denial, however, it is suspected that not only medical aspects but also cost factors play a role in the high proportion of rejected services.

Objection to rejection of rehab measures
The president of the social association VdK, Ulrike Mascher, sees the rejection of medical services such as rehab or a requested hearing aid extremely critical. For example, what was the actual need for rehabilitation measures? „In spite of all saving efforts and a very restrictive granting practice, in 2012 Deutsche Rentenversicherung exceeded the budget for occupational and medical rehabilitation benefits“ said Mascher in a press release in late July. From the advice knew the VdK, „that many rehab applications are rejected first. Only those who object, may eventually come to the train. "

Counterproductive savings efforts of the health insurance companies
The president of the VdK pleaded for an abolishment of the capped budget for rehabilitation services, because the rehabilitation must be fully supported. „Anyone who becomes incapacitated for work on account of illness or disability will burden the welfare system far more than the person who can return to a job requiring social insurance after rehab“, Mascher explained the advantages of comprehensive rehabilitation. According to the information provided by the VdK „It has long been proven that the cost of a vocational rehabilitation can be recouped after three to five years“ become. Spending efforts in the rehabilitation measures could thus lead to financial benefits at the health insurance in the short term, but bring significant disadvantages in the long term. The tightened austerity measures of the health insurance companies would therefore have a long-term extremely counterproductive effect. (Fp)

Picture credits: Thomas Klauer