Capitation through the back door?
29.07.2010 09:37
New general health newspaper for Germany on “forced savings”
Every year again: Whether AOK boss Dr. Herbert Reichelt or Birgit Fischer, CEO of Barmer BEK, whether Ingo Kailuweit, head of the KKH Alliance, or Doris Pfeiffer, head of the National Association of Statutory Health Insurance Funds - they all see bleak for the finances of statutory health insurance next year: 11 billion euros miss. That's why they are unanimously and emphatically calling on politicians to act immediately - that is, of course, to save money. What else?
And so they save again. “You” – this time these are the health politicians Jens Spahn (CDU) and Dr. Rolf Koschorrek (CDU). Jens Spahn graduated from high school in the town of Ahaus in Münsterland and completed a banking apprenticeship in Münster. He has just turned 30 and is already health policy spokesman for the CDU/CSU. Dr. Koschorrek is, after all, an experienced dentist and chairman of the CDU/CSU parliamentary group in the health committee. The heads of the coalition had asked the two health experts to identify four billion (!) euros in savings in the healthcare system and to present them to the coalition committee.
Not easy work for these two, but not too difficult either. Of course, you have to be able to juggle millions a bit, and you have to know the “causes” of the expenditure in the healthcare system: the pharmaceutical industry, the hospitals, the doctors, the pharmaceutical wholesalers and the pharmacies. Then you just have to distribute the four billion to be saved as evenly as possible among all groups - done. If everyone complains, you've done it right.
Let's remember: Hospitals are putting off an urgently needed investment of more than 50 billion euros, and cuts have been made for years in personnel as well as in the remuneration structures for nursing staff. And quite a few patients turn up their noses at the lack of cleanliness in their rooms - this is also a visible expression of cost-cutting measures. Now, at the suggestion of the two experts, hospitals should save another 850 million a year. The costs of the clinics inevitably rise: only recently, after years of blockage, hospital doctors were finally granted more appropriate remuneration. Nobody knows where savings should be made.
But – Jens Spahn knows it: “In metropolitan areas we have too many hospitals rather than too few.” He said this in an interview with the “Ärzteblatt”. Another one of those superficially catchy statements from a health politician, but that doesn't mean it's correct. If it is true that a dramatic aging of society lies ahead of us - and that is the only reason why there are all the discussions about a more crisis-proof future of social systems - then more and more people are getting older and older. And from the age of 60, the proportion of patients in hospital increases dramatically - you can read about it in the federal health reporting on gbe-bund.de. So fewer hospitals? In terms of the future, this is foolish, wrong and dangerous.
Or let's take practicing doctors: Adjusted for inflation, doctors have lost half of their income in the last 20 years. The Hamburg institute Statista determined this in a comprehensive salary report commissioned by the magazine “Stern”. The consequences are visible: dying medical practices in the countryside, exodus of doctors to countries that value their work more highly, and flight into industry. Added to this is the growing number of older doctors retiring. The shortage of doctors in Germany is inevitable.
But the two health experts suggest that half of the urgently needed fee increase that has just been agreed upon should be collected back. That should save 500 million. This will certainly not solve the shortage of doctors in rural areas. Where the doctors are supposed to bleed, the pharmacists cannot be missing. You owe it to justice. The pharmacies in particular have been granted reimbursement for the enormous additional effort in the pharmacies for managing the discount agreements for generic drugs, which are unpopular with everyone involved - except the health insurance companies. The health insurance companies now want to collect it again.
That's not all: 150,000 different medicines and health products are dispensed to patients and customers in pharmacies. A pharmacy cannot keep all of them in stock. You have to order from wholesalers. The logistical effort is enormous. Pharmacies receive a discount for smart and efficient wholesale orders. This is common in every sector of the economy. Many pharmacies find it difficult to survive without this discount. The health politicians Spahn and Koschorrek suggest taking these discounts from the pharmacies and giving them to the statutory health insurance companies - without anything in return, of course. That should bring in 400 million.
The fact that medicines cost money is not new. What is new is that highly effective, biotechnically developed drugs for certain diseases are so expensive due to immense research costs that small health insurance companies can go bankrupt if they only have two or three patients with one of these extremely rare diseases among their insured persons. Among medications, these drugs are the biggest “cost drivers” – that’s what they are called by health insurance companies. And you have to “kill” cost drivers. Every manager knows this. So Health Minister Rösler plans that drug manufacturers will have to negotiate prices for new drugs in the future instead of simply setting them. That sounds good, but who guarantees that manufacturers will not first add the discount to the negotiated price in order to achieve what they consider to be the “right” price? After all, drug manufacturers are also commercial enterprises. And truly innovative medicines are unique – there are no comparable prices.
But savings have to be made. And so a “drug savings package” will be launched on August 1st with a price freeze for medicines and a compulsory discount for drug manufacturers. What's the point? 1.2 billion, 1.5 billion, 2 billion – no one knows exactly. However, all manufacturers should pay, regardless of whether they do research or not.
But compulsory savings are not enough either way. Seven billion are still missing. And the insured people will probably have to pay for this on their own. With a “health bonus”, a “capitation allowance” or an “additional contribution”. No matter what the burden is - you definitely have to expect 20 euros per month. But that will only be the beginning. We will find out more in July. By the way – the health insurance companies spent 8.9 billion euros net on their administrative costs in 2009. Despite all the mergers. No talk of saving.
08.07.2010