Chronically ill through health funds

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Increase in chronic diseases through health fund Since the introduction of the health fund in 2008, chronic diseases in Germany have increased massively. In its current program, the NDR magazine "Panorama" has devoted itself to the topic in more detail and comes to the conclusion that it is not health reasons but financial interests of the health insurance funds that cause the massive increase in chronic diseases.

Financial incentives for chronic diseases Critics already criticized when the health fund was introduced in 2008 that the financial incentives of the new money allocation mechanism are pointing in the wrong direction, since insurance companies will in future have a strong financial interest in a large number of chronically ill insured persons. Because they receive higher allocations from the health fund for the treatment of chronically ill people. Since doctors are also entitled to higher reimbursements for the treatment of their patients, they use the discretion in the report's statement when “coding” the respective clinical picture. Panorama tends to classify patients as chronically ill or seriously chronically ill.

Doctors use scope for coding The basis of the "Panorama" report is a document from the Federal Insurance Office (BVA) which shows that the number of people with serious chronic diseases in Germany rose by 4.6 percent between 2007 and 2008. This sudden increase cannot be explained medically, according to the statements in the NDR report. According to the documents of the BVA, there was an increase of over 10 percent in 23 disease groups, for example the attention deficit disorder increased by 14 percent and the number of diabetes patients by 17 percent. According to “Panorama”, this exceptionally strong increase in exactly the illness that is better compensated for cannot be a coincidence. The Bremen health economist Prof. Gerd Glaeske also emphasized to the reporters that there is an incentive to produce more diseases medically than actually exist. The television magazine assumes "that there are not actually more sick people, but that the numbers are the result of the new billing options". As a result of the morbidity-oriented risk structure compensation (Morbi-RSA) introduced with the health fund, insurance companies and doctors, in the opinion of "Panorama", use all the leeway to achieve the highest possible reimbursement of costs. "The increases can only be attributed to the coding method and not to the fact that the number of illnesses has actually increased here," said Prof. Glaeske in the report.

Massive increase in chronic diseases recorded The BVA has cataloged 80 clinical pictures for which health insurance companies can make higher demands. According to "Panorama", the documents of the BVA show that the percentage increase in 23 of these 80 diseases was in the double-digit range. For the treatment of patients with the relevant diseases, the statutory insurers have a total of 86 billion euros available. Even if the reporting from "Panorama" and the statement by the umbrella organization of statutory health insurance: "The financial equalization is still in the development process, but must of course be tamper-proof" clearly shows that not everything is going in the right direction, the Federal Ministry of Health continues A spokesman for the ministry denied any suspected connection between the financial reimbursements and the increase in chronic illnesses to "Panorama" The "basic evil" of the "incentive to code for sick", also addressed by the Bremen health economist Prof. Glaeske, is not recognized by the Ministry of Health.

Patients suffering once more From the opposition, however, the first critical voices report. Karl Lauterbach, health expert at the SPD, criticized the fact that doctors who can document diseases "at their discretion" are subject to a high incentive to have a "documentation contest" with colleagues and to lead as many patients as chronically ill as possible. "Such a system invites you to cheat", because the doctors' fees are also based on the Morbi RSA. Lauterbach, on the other hand, does not mention that he himself contributed to the development of the model during the introduction of the health fund under SPD Minister of Health Ulla Schmidt. In any case, the patients are once again the sufferers. An incorrect coding of the clinical picture by the doctor can have far-reaching consequences. Those diagnosed as chronically ill because of a slight problem can later have problems with insurance or starting certain professions. Sometimes an incorrect diagnosis can have lifelong disadvantages, because "the files run through the entire system", explained Karl Lauterbach. (Fp, 15.10.2010)

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