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Health fund: only those who are sick bring money!
The health fund introduced by the grand coalition is now revealing its weaknesses. The insured are turned into sick people in order to get more money from the health fund. The health fund was originally set up by the grand coalition to guarantee fair competition among health insurers. A lump sum from the health fund is paid for each patient, and there are additional grants for 80 selected diseases. This includes acute pneumonia or chronic conditions such as diabetes. What is striking in this context is the dramatic increase in the number of diseases that were put on the list by the CDU and SPD.
Now the doctor's office no longer looks at the budget, but rather at which disease makes the most money. This is the guiding principle for diagnosing and prescribing. According to Mirror online the health insurance companies should have addressed the doctors specifically and asked for a diagnosis that was as profitable as possible. In return, the doctors are said to have been paid a higher fee. Apparently health insurance companies and doctors are working hand in hand to get as much money as possible from the health fund. A side effect of this practice is that the proportion of sick people in Germany has increased rapidly. Anyone who does not play this game is a loser: The money is paid to the health insurances, which know which diseases can earn the most money. Optimal are those diseases that generate high grants from the health fund, but for which the treatment costs are low. Wolfram Richter, one of the fathers of the health fund, describes this approach in an interview with tagesschau.de as an initial problem. According to the judge, the Federal Insurance Office will take a close look and take action against such behavior. But here, too, there are doubts that the Federal Insurance Office will be able to control the billing practices of doctors. For example, a doctor only has to leave out the "V" for a suspected diagnosis from a diagnosis and a probably healthy person becomes a sick person for whom the health insurance company receives the money.
One advantage of the health fund is that you can now make money when the insured are sick. So far, only the health of the insured has paid off for the health insurance companies. But never before has so much money been spent in the health sector as in 2009, the health fund will pay out around 170 billion euros this year. That is almost 10 billion euros more than in the previous year. If the money in the health fund is used up, the health insurance companies can fall back on their members and demand additional contributions from them.
According to Richter, in the long term it will mean that every German basically has two insurances: A basic insurance that covers everything medically necessary and that is financed through the health fund on a solidarity basis, with the health insurers competing with additional contributions and bonuses. Most citizens will, however, take out additional insurance. The question that now arises is who defines what is medically necessary? And why does Mr. Richter assume that two insurance policies will be necessary if the essentials are to be covered?
It is to be hoped that the politically responsible will find a system of accounting and financing in which it is possible to provide medical care for every person according to their needs. (sb)