Too many heart surgeries because of financial interests

Consumer Centers: Criticizing Cash Inducements for Cardiac Surgery

07/22/2014

According to the opinion of the consumer centers, heart patients in Germany may be operated too often. It remains unclear whether alternative therapies would not sometimes be better. Sales incentives that are available for clinching operations could play a role in this.

„Financial interests of hospitals“
According to consumer centers, patients in Germany may be subjected too often to heart surgery and other clinic procedures. „There are financial interests of the hospitals, which act for plannable, large interventions“, explained the health expert of the consumer association Federal Association, Ilona Köster-Steinebach, opposite the news agency dpa in Berlin. This also applies to the increasing number of cardiac surgery. „It therefore raises the question of whether surgery is always the best treatment option“, so Köster-Steinebach. For example, in the case of heart surgery, medications could be alternatives or more exercise, weight reduction and physiotherapy.

Number of heart valve surgeries has risen sharply
The health insurance company Barmer GEK is presenting a study on hospital treatment in Germany this Tuesday in Berlin. Every year, several hundred thousand heart surgery for coronary artery obstruction is the focus of the Hospital Report 2014. Most of these procedures involve introducing balloons into the constricted vessels via catheters and expanding them there. There are also tens of thousands of bypass operations every year. Köster-Steinebach also mentioned cardiac valve surgery as an example of a strong increase in the number of operations. There were 11,700 such procedures in 2008, of which 11,200 were classic chest opening surgery. But by 2012, the number of heart valve surgery had risen sharply to 19,200, with the number of classic interventions had fallen by 1,200. But there have been more than 9,000 such procedures after a newer method, after a replacement flap folded over the catheter is introduced.

Patients should seek a second opinion
Even if this newer variant is less stressful - for example, for older patients - it still carries the risk of serious side effects, as Köster-Steinebach reported. Therefore, there are doubts as to whether the increase is medically justifiable. The health expert also pointed out that patients should be careful to explain treatment alternatives when doctors advise them to plan a major procedure. So they should clarify the question of what the waiver of surgery would mean, and get a second doctor's opinion. Also the health expert from the consumer center North Rhine-Westphalia, Regina Behrendt, had advised only recently in a discussion with the news agency dpa to catch up with uncertainties a second opinion. „Ask what opportunities and risks are involved“, so her recommendation. The doctor is legally obliged to comply with his obligation to inform and inform his patient. SPD health expert Karl Lauterbach had recently advocated that the second opinion should be paid by the coffers.

Appeal to health policy
Ms. Köster-Steinebach also cited the example of certain stents, which were increasingly being used to combat vascular constriction in the heart. She explained that many of these interventions would not be to lower mortality but to improve quality of life. „The problem is that no one is investigating the quality of life achieved or its improvement after the intervention.“ The expert called on health policy to shift the financial incentives for clinics away from large, predictable operations to emergency and primary care. Based on their findings, the Barmer GEK claims to be able to provide information for the planned hospital reform. This project is currently being negotiated in public by the federal and state governments and representatives of the coalition groups in a joint working group.

Improve treatments for poor performance quickly
Ms. Köster-Steinebach objected to implementing the discounts for clinics considered by the black-red coalition with comparatively poorer performances. She explained: „In retrospect, this does not do much to affected patients.“ Rather, clinics should rapidly improve or no longer offer treatments for poor performance. Every year, the number of in-patient treatments in German clinics increases by around 220,000 to 340,000, as researchers from Hamburg and Berlin found out in the context of a legal opinion. And that with almost the same population size. Germany ranks second in the OECD after the top performer in terms of treatments per inhabitant in the OECD. (Ad)