Manipulations in the diagnosis recording?
11.10.2016 10:51
The chairman of the AOK Federal Association, Martin Litsch, is more than astonished by the allegations of manipulation made by the chairman of the Techniker Krankenkasse (TK), Jens Baas, who in an interview with the Frankfurter Allgemeine Zeitung accuses the health insurance companies of trying to persuade doctors to make an extended diagnosis. “Then there will be more money from the risk structure equalization, which is intended to compensate for high and expensive health risks among the individual health insurance companies,” says Baas. Litsch disagrees.
“This all-round attack against doctors, regulators and health insurance companies by the head of the largest statutory health insurance company astonishes everyone. Does he really mean that doctors manipulate diagnoses on a massive scale for an additional fee of ten euros and thereby violate the Hippocratic Oath?" asks Litsch.
“Where are federal and state governments neglecting their supervisory duties? And how should we understand the claim that the TK could reduce its contribution rate by another 0.3 percentage points if there were no manipulation? In 2015, a contribution rate of 0.3 percentage points at TK corresponded to around 500 million euros,” explains the chairman of the AOK board.
All of this remains Baas's secret and doesn't really fit in with the largest German health insurance company, which has been recording above-average membership growth for years, charges a below-average contribution rate and recently made a surplus of 165 million euros, criticizes Litsch and identifies the "early Halloween campaign" Bass' as a discrediting of the risk structure adjustment (RSA) and uncertainty on a broad front. “Apparently he doesn’t like the fact that risk selection at the expense of chronically ill people is no longer worthwhile for his health insurance company. But instead of admitting this, he prefers to portray the RSA’s data base as highly susceptible to manipulation,” analyzes Litsch.
Baas' clear goal is to change the allocations from the health fund to the advantage of his fund or type of fund by dismantling the RSA and thus to be able to offer a more favorable additional contribution rate in the health insurance competition in the future. “Only recently did the replacement funds agree to share 500 million euros as 'loot' from an adjustment to the RSA among themselves. This creates new risk selection incentives and reduces economic incentives. From a socio-political perspective, this is more than retro,” explains the AOK board chairman.
The AOK has been committed to a non-discriminatory healthcare system and fair competitive conditions for years. Financial equalization should not allow risk selection. Therefore, one should not bring the data bases, doctors and supervisors into disrepute, but rather offer solutions. “We have long been calling for the RSA to be made more resistant to manipulation and for uniform coding guidelines to be introduced in outpatient care. We warmly invite Mr. Baas to actively support us in this,” concludes Litsch.