Expensive diagnostic procedures increase costs

Medical Report of the Barmer GEK: Spending on diagnostic imaging procedures such as magnetic resonance imaging has led to a steady increase in health care costs. In addition, the report has revealed that Germans are increasingly going to the doctor.

01/02/2011

Spending in the healthcare system is increasing year by year. According to medical reports 2011 of the health insurance Barmer GEK every second in Germany goes on average at least four times to different doctors. Medical achievements, such as magnetic resonance imaging (MRI) diagnostics, are pushing up health care spending. In a worldwide comparison, the Germans most often go to the nuclear spin.

Again and again remind the health insurance, the Germans too often go unnecessarily to the doctor. How many visits to a doctor are really necessary and how many more belong to the category unnecessarily, has hardly been investigated so far. What is certain, however, is that the doctor's visits in recent years to take continuously. In the meantime, every tenth German goes to six different doctors per year. One percent of patients even go to different doctors ten times. The collected data come from an evaluation of the health insurance company Barmer GEK, which, with 8.2 million insured persons, belongs to the German industry leaders. On the basis of the patient data, a good average value can be determined for the total population in Germany. About 10 percent of people are insured with the Barmer GEK.

Every second person goes to different doctors four times a year
According to study data, 41 percent of the patients went to at least four different doctors each year. The average was 3.4 different examinations by different physicians. However, the study authors did not announce the exact number of patients. The billing system of the health insurance companies was changed according to which doctors are no longer reimbursed for patient contacts. However, a look at the previous year's report from 2008 reveals that every health-insured person takes about 18.1 doctor visits a year. Health experts assume that the number of doctor visits in the following year alone has increased rapidly due to the swine flu hysteria in 2009 alone. The absolute top reasons for visiting a doctor were back pain. Almost a quarter of all sufferers suffered from a back problem. In second place ranked the respiratory infections with 18.5 percent. About 7.8 percent of patients were severely overweight (obesity) and 6.9 percent are in continuous treatment because of type II diabetes. Barmer GEK was also able to register a further increase in mental and emotional illnesses.

Technical diagnostic methods as cost drivers
Magnetic resonance imaging (MRI) and computed tomography (CT) are among the technical achievements of conventional medicine. During diagnostics, physicians can create and evaluate sectional images of inner body regions. The method is used, for example, to detect cell changes early and to evaluate pathological symptoms or damage. If the new types of diagnosis were still celebrated as a medical achievement, today more and more are emerging as cost drivers. It seems that primary care physicians use MRI as an exclusion diagnostic procedure to calm patients with actually harmless symptoms. Since 2004, the proportion of those who used a magnetic resonance lock at least once in their lives increased by 41 percent. In the CT procedure, it was after all 26 percent, as it was called in the medical report 2011. At least six percent of all Germans had at least one computed tomography performed each year. At the MRT it was already 7.2 percent. Germany is in the world leader in the absolute top range. There are currently 97 nuclear spin examinations per 1000 people. Most frequently, the head, legs, arms, abdomen and spine are examined. Most commonly, the method is used to exclude or detect cancers, inflammation and bone damage.

CT and MRI examinations often unnecessary
Whether the imaging techniques should actually be used so often is to be doubted. CT is X-rays from a rotating tube, and MRI (magnetic resonance tomography) is a magnetic field excited from the outside by radio waves. In the case of CT X-ray examinations, patients are exposed to a sometimes high radiation dose whose possible consequences have not been adequately investigated to date. It is clear that such procedures increase the lifelong radiation exposure of patients. They then come together quickly 60 percent of the total burden of those affected, said Barmer GEK Vice-Rolf-Ulrich Schlenker. For this reason, Friedrich Wilhelm Schwartz from the Institute for Social Medicine, Epidemiology and Health Systems Research (ISEG) doubts whether the frequency of the investigations also says something about the actual benefit. Although one can not exactly quantify in how many cases, for example, the MRI draws a meaningful treatment in knee examinations, however, doctors will diagnose a pathological finding in most cases.

Exclusion diagnosis by MRI and CT?
Doctors rely on MRI or CT scans for all sorts of suspicions. However, in retrospect, the results are often mispriced. In many cases, no adequate therapies were available or the diagnosed lesions were not treated afterwards. In some cases, although damages are treated, however, the patients did not previously suffer from any health-impaired persons. The authors of the medical report consider it possible that the professionally created colorful body images contribute to the fact that many patients demand and agree to this. In contrast, patients are often inadequately informed in advance by their family doctor. The report also found that physicians spend only eight minutes on average to examine a patient.

High cost development for the healthcare system
According to the health insurances, the CT and MRI procedures cause around 1.7 billion euros every year. In view of this high output page, deputy chief treasurer Rolf-Ulrich Schlenker demands that expensive diagnostic procedures should only be used if it makes sense from a medical point of view. In addition, Schlenker drew attention to the fact that continuous applications increase the radiation exposure in patients. In Switzerland, an evaluation showed that in less than 50 percent of all examinations, a therapy took place. A similar result could apply also for the Federal Republic, so the health expert. On average, about 700 euros cost an imaging process. (Sb)

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Picture: by-sassi