Catch premiums in healthcare



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Do health care premiums decide?

Many doctors collect premiums for referring patients to certain clinics or colleagues, according to the results of a recent study commissioned by the umbrella organization of statutory health insurance companies. "Catch premiums are not an exception in German health care, but common practice," the association comments on the study results in a current press release.

For the executive board of the umbrella organization of statutory health insurance (GKV), Gernot Kiefer, the catch premiums hold considerable corruption potential. Because in case of doubt, bonus money or benefits in kind decide "to which doctor, to which clinic or to which aid provider patients are directed", the GKV head association announced on Tuesday.

Need a patient transfer for a fee? On behalf of the National Association of Statutory Health Insurance Funds, the researchers led by study leader Professor Kai Bussmann from the Economy & Crime Research Center at Martin Luther University Halle-Wittenberg had a closer look at the premium payments to doctors. The study is based on "a self-assessment and industry-specific assessment of medical service providers regarding the knowledge and application of legal norms as well as the practice of targeted referrals", explains the GKV head association in the press release "Study proves: referrals against remuneration are not individual cases - considerable corruption potential". Across Germany, "600 resident specialists, 180 senior employees of inpatient facilities (hospitals, rehabilitation and spa facilities and nursing homes) and 361 non-medical service providers (e.g. pharmacies, medical supply stores, hearing aid acousticians or orthopedic specialists) were surveyed". The result is terrifying: 14 percent of doctors said that allocations against economic benefits were common, 35 percent saw it at least in part. A total of 20 percent said that a similar approach to other doctors or services is common. Catch premiums appear to be even more widespread in inpatient facilities, of which 24 percent describe remuneration for remuneration as common practice, and among non-medical service providers, 46 percent of whom consider catch premiums to be normal.

Catch premiums in the health care system are not uncommon The GKV umbrella association criticized the spread of the catch premiums in the health system. Accepting fees for referring patients is actually prohibited, but numerous doctors do not seem to abide by this. The board of the GKV umbrella association, Gernot Kiefer, emphasized that he was "sure that many service providers act correctly", but "if you can see from the self-assessment of the industry that every fifth doctor does not know the professional law prohibitions and at the same time assignments for a fee is also a matter of course, which is a scandal. ”In fact, the answers of the doctors to the question about the premium payments do not only astonish critics. According to extrapolations, "more than 27,000 practicing contract doctors are already violating professional law today," according to the GKV umbrella association. "If criminal law were applied here, it would be clear what high corruption potential there is in the German healthcare system," emphasized Gernot Kiefer.

Applying Corruption Criminal Law to Doctors According to the study director Professor Kai Bussmann, “the common practice of allocation remuneration perceived by the study participants lives in many cases from the fact that the risk of detection for the individual actor is relatively low and the disadvantages for the profession and the health system as a whole are far away. "The lack of controls and sanctions" also means that "assignments for a fee appear to be a low-risk, minor offense," added Gernot Kiefer. However, the acceptance of fees for the transfer of patients is by no means a trivial offense, according to the board of directors of the GKV umbrella association, which is why "the statutory health insurers will make greater use of the new social law options" in the future and even want to withdraw the approval from the contract doctors in an emergency. "Patients must be able to rely on the fact that doctors recommend a particular clinic or laboratory for medical and not for monetary reasons," emphasized Gernot Kiefer, demanding that "as a last resort, corruption criminal law should also be applied to doctors in private practice". (fp)

Image: Rainer Sturm / pixelio.de

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