Unnecessary operations by professionals of the clinics

Clinics tend to unnecessary surgery out of pure economic interest

05/30/2012

Obviously, in hospitals some superfluous operations are carried out for economic reasons, according to the startling result of a study by the Rheinisch-Westfälisches Institut für Wirtschaftsforschung Essen (RWI) commissioned by the umbrella association of statutory health insurances.

"There are many indications that due to economic incentives, medically unnecessary services will be provided in the clinics", explained the Deputy Chairman of the GKV-Spitzenverband, Johann-Magnus von Stackelberg, with reference to the RWI study in a recent press release. Apparently the clinics are increasingly guided by financial interests, instead of putting the medically necessary in the foreground of the treatment.

Economic interest of the clinics A reason for increased operations
According to the statements of the RWI expert opinion, many patients of purely economic interest of the clinics are exposed to an unnecessary surgical risk. Overall, the "number of hospital cases and the respective billed severity seems to be unstoppable", with "only a part of this increase can be explained by the demographic development," according to the statement of the GKV-Spitzenverband. "You have to be more and more careful that you do not come under the knife," commented the hospital expert of the GKV umbrella organization, Wulf-Dietrich Leber, the increase in operations against the news channel "ntv". In the case of significant increases in knee and hip prostheses as well as in spinal interventions, it can be assumed that the limit of what is medically reasonable is exceeded. Overall, according to the RWI study, between 2006 and 2010 there was an increase in weighted hospital treatment - the so-called case mix - of 13 percent. However, only 40 percent of the increase was due to the aging of the population, reported the study author and health expert of the RWI, Dr. med. Boris Augurzky, at the presentation of the study results in Berlin. "According to the experts, the amount of benefits since the introduction of the lump sums per year increases by about three percent," which can not be explained by the demographic development, stressed the GKV-Spitzenverband in his press release. According to the hospitals provide "apparently a part of the additional benefits for economic reasons alone."

Price increase as a cause of unnecessary operations
According to the RWI report, the main reason for the economically motivated interventions is also the price increase for various interventions. "Overall, the price increase from 2007 can explain a significant proportion of the number of case numbers," said the statement in the study of the RWI. For individual Diagnosis-Related Groups (DRGs), marginal costs are well below full costs and thus, for one additional case, the revenue is higher than the costs, so there is a strong incentive to increase the quantity, "Dr. Augurzky and colleagues in their report. The marginal cost is the cost incurred by additional treatment of the patient, with fixed costs that are independent of the number of treatments (for example, building costs) not added here. If a patient is already being treated at the clinic, the marginal cost of an additional procedure is often significantly lower than the compensation provided for this purpose. Accordingly, it may well be worthwhile for hospitals to simply offer patients more services, regardless of whether they are required or not?

Unnecessary surgical risk for the patients
However, in cases of doubt, the clinicians have an unnecessary surgical risk for patients, which is why measures are also required from the health insurance funds to avoid superfluous, purely financially guided operations. "In the short term, we need price and quantity stabilization and, in the medium term, we need new models to control volumes, especially in terms of predictable operations," said Johann-Magnus von Stackelberg. "It must be the common concern of clinics, patients and health insurances that the incentives for medically unnecessary surgery be reduced," said the chairman of the GKV-Spitzenverbandes. In general, therefore, the GKV-Spitzenverband welcomes the fact that politicians have also devoted themselves to discussing new forms of quantity control in the treatment of clinics. However, with the current proposals, there is a risk that the problem will further intensify.

Sustainable proposals to eliminate the quantity problem asked
The currently in-room discounts for additional services - additional interventions in a patient already in treatment, should be paid less - can only in the short term "reduce the incentive for hospitals to provide economically induced and medically unnecessary services," the statement in the Press release of the GKV-Spitzenverband. Because prices are not effectively limited under the legislation, there is still an incentive to go into quantity. In the long term, therefore, other solution models are needed to eliminate the quantity incentives. By the coming year, the clinics and health insurance companies will develop a proposal for sustainable solutions to the issue of quantity. However, it must also be ensured in the short term that "there is no price problem for the quantity problem by focusing on the orientation value and refinancing of collective wage increases," emphasized von Stackelberg, adding: "Higher prices increase the incentive to add more in purely economic terms provide. "(fp)

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Picture: Martin Büdenbender