PKV and doctors argue about fees

PKV wants to save on medical fees

Reform of the medical fee schedule: Fee dispute between doctors and private health insurance companies comes to a head.

(10.12.2010) The dispute between private health insurance (PKV) and the medical profession about the design of the fee regulation is getting to a head. While the PKV association demands from the black and yellow federal government an “opening clause” for the announced reform of the medical fee schedule (GOÄ) in order to be able to negotiate dental and medical services outside of the state GOÄ, the doctors vehemently oppose such a transformation the scale of fees. The PKV hopes that the "opening clause" will increase competition among doctors and thus lower costs, but the medical profession fears price dumping combined with a corresponding drop in earnings.

PKV demand "opening clause" in the fee schedule Apparently inspired by the concessions to which the Federal Minister of Health Dr. Philipp Rösler (FDP) paved the way as part of the health care reform, private insurers are going on the offensive and are not only demanding that the federal government modernize GOÄ fundamentally, which should bring more transparency to the fee regulations. They also require the introduction of an "opening clause" so that in future they can negotiate directly with doctors and dentists about services and the costs involved.

This regularly presented proposal of selective contracts meets with massive criticism among doctors. Both the German Medical Association (BÄK) and the German Society for Insured and Patients (DGVP) see the "opening clause" as a "serious risk to medical and dental care". The medical profession and the private health insurance, however, agree on the point that the fee regulations for the medical profession urgently need to be revised. Because the GOÄ, which regulates the fee payments for the respective medical services, has not been updated for decades. This results in an unmistakable discrepancy between the stipulated benefits or remuneration and the medical-technical reality. Numerous new innovative treatment methods are not even covered in the previous service catalog. Therefore, the federal government from the CDU / CSU and FDP wants to start modernizing the GOÄ next year, which explains the current showdown between private health insurance and the medical profession.

Doctors fear price dumping The targeted competition among doctors would be “ruinous”, since the increased cost pressure would lead to a decrease in the quality of treatment, according to the position of the BÄK and Peter Engel, President of the German Dental Association (BZÄK), even speaks of an “aldization of medicine”. In addition to the foreseeable price dumping, the selective contracts made possible with the "opening clause" would also affect the free choice of doctor and the freedom of therapy, so the fear of the medical profession. The doctors advocated a continuation of the current state fee regulations similar to their previous form, since they have a "protective function" for the doctors and patients. In any case, the "opening clause" only uses the PKV to control patients and to increase their own profits, according to the position of the doctors.

Private health insurers emphasize the “achievements of freedom of contract”. The position of doctors, however, is not understandable for private health insurance. “The freedom to negotiate and the instrument of the contract are older than German social security. They are part of the nature of our liberal society, ”Reinhold Schulte, CEO of the private health insurance company Signal Iduna, told the journal“ Apotheken Umschau ”. Schulte criticizes that on the one hand the doctors always emphasize their freelance work, but apparently they don't know what to do with the “achievement of freedom of contract”. "You would rather prefer a centralized governmental regulation rather than negotiate a transparent agreement yourself," said Schulte, explaining his view of the medical position. The doctors “are in fact advocating a state ban on negotiations. Nobody would have expected that from a freelance profession, ”continues Schulte.

The cuts feared by the medical profession in the form of budgeting or capping of expenditure are, according to the PKV association, unfounded. Appropriate approaches are not in the concept of private health insurance to reform the fee regulation, but the PKV only wants an "improvement in quality" without rigid specifications that offer no possibility of deviation.

PKV hope to save costs
The PKV association does not deny that private insurers also want to use the “opening clause” to reduce their expenses in order to be more competitive and future-proof. Because in view of the growth in expenditure on outpatient services between 2007 and 2009 of more than twelve percent and similar increases in the area of ​​dental services, there is an urgent need for action from the perspective of private health insurance companies. From the perspective of the private health insurance company, the “opening clause” should not pose a problem for doctors either, because even with the proposed adaptation of the GOÄ, the contracts between doctors and private health insurance companies can only be concluded by mutual agreement, that is, they can be made to mutual satisfaction. However, private insurers are silent about the fact that their negotiating position for the relevant contracts is likely to be far better than that of medical professionals. With their market power, they would be able to significantly lower prices for medical services, which would not necessarily be of benefit to patients and certainly would be of disadvantage to doctors. (fp)

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