Tuesday, October 11, 2016

Health insurance – a crisis of confidence in the health system Süddeutsche.de

It would be a scandal: health insurance companies should have money by devious means. Now, you need to ensure that citizens can have confidence in the health system.

comment by Kim-Björn Becker

although It is not recorded, whether the head of the largest German health insurance Fund regularly goes to the cinema. Nevertheless, Jens Baas of the technicians health insurance company seeks the metaphor of the cinema, to describe a process that, if it is true, the makings of a political health scandal. It is in this matter of contracts, which the various health insurance companies to have partnered with community-based Physicians./p>

Therefore, to leave the doctors to their patients on paper in case of doubt, more sicker than healthier appearance, a fee for his services and the Fund, in turn, more money from the big pot of the insured funds. This behavior, wrote Baas recently in an article for a trade magazine, was “comparable with the Situation to see if in the cinema stands up”: a bit, need to raise the visitors to behind it also. And in the end, Baas, “make all”. For him, the cinema hall provided the perfect picture to show why his Fund could not “completely withdraw”.

the shameful handling with insured funds, is reinterpreted for the alleged coercion. At first glance, it seems like a paradox, what is the Fund Manager offers to the Public here. Finally, there is everywhere evidence that patients in Germany are not able to actually be healthy enough – many are sent to an Operation in the hospital faster back home than you can remember the name of the surgeon.

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The tampering charge, the Jens Baas against his own cash – but especially against the rival AOKs is -has something to do with a complicated health-policy control instrument. This has introduced in the legislature to make the competition between the funds fair. It’s about how the money is to be distributed from the health Fund to the sickness funds; the idea is that If a Fund has many of the Insured who are particularly sick, you should get more money – because the treatment of these patients costs them more.

What sounds like a smart and level-headed, generated in the thicket of the health policy interests’, but soon new problems. Because all of a sudden it is for the cash, in fact, interesting, if a Patient is on the paper is a little sicker than it is in reality. The difference between appearance and being is to make money. Now no cash, lays down a but, how hard someone is sick. The power of the attending physician. He transmits the diagnosis, for example, high blood pressure, in a Code.

The maneuvers of the engineer-heads is controversial

In this case, these represent different degrees of severity – almost 4000 encodings are from the point of view of the funds to be relevant, because you can then get more money. In the current dispute, it is therefore a first and foremost a question of whether Doctors are to be misled by fee-based contracts, either as precisely as possible, or to diagnose as profitably as possible – it’s a fine line, no doubt.

What do it is the Insured here in Detail, it must now be determined by prosecutors. The evidence that it really is as Baas asserts, condense, court proceedings are inevitable. Until then, however, the confidence of the Insured to the German health care system suffers again and the process nourishes the suspicion that funds and Doctors shamelessly over the hard-earned health insurance contributions from the employee.

Finally, the most recent maneuvers of the engineer-in chief is not uncontroversial: That a leading health insurance company said, the end to your evil deeds, just to make the healthcare system better and fairer, there are now really only in the movies.

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