AOK Hospital Report: Out of greed operations

AOK Hospital Report 2013: Spinal surgery is often unnecessary

The number of expensive operations has increased significantly in recent years. This is confirmed by the AOK Hospital Report 2013. While the hospitals see the cause of the increase in the older population as well as medical progress, the health insurance companies accuse the clinics of often putting their economic interests in the foreground. Above all, expensive spine, knee, hip and heart operations are said to be unnecessary. Even before the official publication of the AOK Hospital Report 2013, the clinics submitted a counter-opinion that came to a completely different judgment.

Many operations for economic reasons? According to the AOK Hospital Report 2013 presented on Friday, costly spinal surgery and heart operations were said to be unnecessary for hundreds of thousands of patients. The AOK federal association evaluated more than 45 million patient data from the years 2005 to 2011 and came to the conclusion that the clinics often put their economic interests in the foreground. However, treatment with the latest surgical procedures is not always sensible.

According to the AOK report, the number of hospital stays has increased by 11.8 percent per inhabitant since 2005. Within 20 years (1991-2011) the number of inpatient treatments increased by almost a quarter. 18.3 million hospital treatments were carried out in 2010 alone. According to the statistics, almost every fourth German is operated on in a clinic. According to the hospital report, the increasing number of costly interventions is particularly noticeable. "Only a third of the increase is due to demographic development and medical progress," said Uwe Deh, board member of the AOK federal association.

Chief physician contracts with surgery bonuses criticized The umbrella organization of health insurance companies had recently criticized German clinics, since many operations would take place without compelling medical reasons. The agreements on bonuses for surgeries contained in many chief physician contracts, which represent an additional financial incentive, are seen as particularly problematic. Even the German Society for Surgery advises to push these agreements back out of the contracts. According to a study by the management consultancy Kienbaum, almost half of the new chief physician contracts are now being expanded with agreements on bonus payments. This means that a chief doctor receives a generous supplement to his salary from his hospital if he achieves certain goals, such as 30 percent more artificial knee joints.

According to a study carried out by the Rheinisch-Westfälisches Institut für Wirtschaftsforschung on behalf of the health insurance companies, the number of “orthopedic treatments has increased by 14 percent in the last four years”. Cardiological procedures even increased by 17 percent. Almost two thirds of the increase is not due to the increasing number of older people, the study says.

Counter-expert opinion should justify increase in operations Immediately before the AOK hospital report 2013 was published, the German Hospital Society submitted a counter-expert opinion in order to counteract allegations of unnecessary operations carried out for purely economic reasons in advance. According to the study, there has been a significant increase in medical interventions, but this is due to the fact that the number of older people is steadily increasing and medicine has made great strides. "A general defamation of the hospital staff and an unsettled insecurity of many patients must therefore be rejected," according to the survey by the German Hospital Institute according to the German Press Agency (dpa). Accordingly, there are undeniable economic false incentives. Especially for the numerous operations artificial hip and knee joints as well as pacemakers and cardiac catheters would give “solid indications.” These interventions would therefore not be arbitrarily ordered and carried out by doctors.

According to the study, "the largest increase in the period from 2007 to 2011 was seen in therapies of the circulatory system and the musculoskeletal system". An additional 532,000 cases were registered, which were "settled using the standard procedure". Overall, an increase in treatment cases "from 6.7 percent to 17.7 million per year is calculated". Most patients (two out of three) would be referred to the clinics by resident doctors. The rest come to the clinics as an emergency, according to the hospital institute. There, it is not a doctor who alone makes the decision about therapies and procedures, but the multi-eye principle applies. It remains to be seen whether this will invalidate the reproach of the health insurers.

Strong increase in heart and back surgery The AOK Hospital Report 2013 shows that pacemaker surgery increased by a quarter between 2008 and 2010. In the case of interventions in the back area, the number of people insured with AOK even more than doubled between 2005 and 2010.

The regional differences are striking. In Bavaria and Schleswig-Holstein, for example, “back operations are performed more than 50 percent more often than in Berlin”. Karl-Walter Jauch, President of the German Society for Surgery, told the Rheinische Post that there is a real competition between the clinics, especially in metropolitan areas such as large cities. This would mean that patients would not only be treated in hospital for medical reasons.

The AOK report also analyzes the quality of treatment in the clinics. Complications and adverse events in the 614 clinics examined were compared. There were no problems in 74 hospitals with catheter patients, but in 34 hospitals the complication rate in catheter patients was 15 percent. Therefore, in future there should be the possibility for the health insurers not to "pay for demonstrably poor quality" in order to "separate the wheat from the chaff", explained Uwe Dreh. Around 1,600 hospitals in which AOK insured persons were treated, from a total of around 2,000 German hospitals, were included in the evaluation. (sb)

Read on:
Too many operations in Germany
New doctor portal against unnecessary operations
Health: number of surgeries rose sharply
Study: Many operations are unnecessary
Unnecessary operations by professional clinicians
Around 15 million operations a year

Image: Martin Büdenbender /

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