Doctors advocate reimbursement

Healthcare reform: Doctors speak out about reimbursement

Despite increasing criticism, the Federal Minister of Health Philipp Rösler (FDP) insists on his plan to introduce the reimbursement model in the future. The doctors praise the Minister of Health for this, after all they hope for higher fees. Criticism comes primarily from the ranks of consumer protection and health insurance companies.

Similar to private health insurance, the FDP Minister Rösler wants to introduce reimbursement every time he visits a doctor. Insured persons should pay in advance for each visit to the doctor and only submit all bills to their health insurance company at the end of the year. The principle should be voluntary, as the minister emphasized. But consumer advocates fear that this will introduce three-class medicine. The medical associations see it completely differently. They are demonstratively behind the plans. So the chairman of the National Association of Statutory Health Insurance Physicians, Andreas Köhler, called the plans on Friday as "profound", but an indispensable step towards controlling health care expenditure.

Reimbursement model to start next year
After the major health reform, which has already been largely adopted by the federal government, the health minister plans to tackle the project. Before that, however, according to a spokesman for the ministry, the doctors' fees should be reformed. Only then should a "serious accounting system" be adopted for the insured. With an amendment to the law, Philipp Rösler wants to "motivate" patients to pay an invoice each time they visit a doctor. The insured should then get the costs back from their health insurance companies. "It is and remains voluntary, nobody is forced to do it," as a spokesman for the Federal Minister of Health emphasized on Friday.

Medical associations were entirely in favor of such a reform. Patients would take more responsibility for it, as it was said. A new model of personal contribution or reimbursement could address the problem of unlimited demand for medical, outpatient health services. "Only then will it be possible to get away from the high number of visits to the doctor each year," argued head of the physician, Andreas Köhler. This is the only way to ensure that the high number of sometimes unnecessary visits to the doctor is reduced.

Health insurance against medical bills
But are the doctors arguing very unselfishly here? Health insurance companies also ask themselves this question. "If you now hear how loudly the medical representatives call for reimbursement, then all alarm bells must ring," criticized the health insurance company spokesman Florian Lanz. Lanz rejects the prepayment for every visit to the doctor and thus the model for reimbursement of costs. Jürgen Graalmann, deputy AOK chairman, told “Bild” that the model cannot solve any problems in the health system. It only unsettles the patient and "brings more administrative effort to everyone".

With a reimbursement of costs, doctors could bill their fees directly with the insured, regardless of whether the health services are actually reimbursed later by the health insurance companies. Because the health insurers often do not pay for certain services if the doctors are not qualified to do so. This happens relatively frequently in everyday treatment, as treatments from different specialties overlap. The patients then lose out, because they then remain at the expense, as the Federal Association of Consumer Protection has criticized. It can quickly happen that many insured are insecure because they no longer see through the different health services. So every treatment would have to be negotiated with the cash register.

Further additional contributions are not excluded
Despite the increase in premiums from next year, the insured may continue to receive additional premiums in 2011 despite all the assertions made by the Minister of Health. For example, the chairwoman of the Federal Association of Statutory Health Insurance Funds, Doris Pfeiffer, told the Inforadio “rbb” that the overall financial situation at the health insurance funds is stable. However, some health insurance companies in particularly expensive cities could give additional additional contributions due to financial gaps. For this reason, further structural reforms, especially in clinics, are necessary. (sb, 10/02/2010)

Also read:
Cash registers: Additional contributions in 2011 are not excluded
Rösler plans to pay in advance when visiting the doctor
Private health insurance: is it worth changing?

Photo credit: Claudia Hautumm /

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