Savings course of the health insurance companies at the expense of the patient

Savings course of the health insurance companies at the expense of the patient

Hundreds of thousands of patients are rejected for desired services

The statutory health insurance funds apparently are pursuing a stricter austerity policy and are increasingly denying insured persons certain benefits. Hundreds of thousands of health insureds received negative feedback from their insurance company in 2012 on benefits such as rehabilitation measures, aids or sick pay, reports the news agency "dpa", citing current figures from the Medical Service of Health Insurance (MDK).

Most statutory health insurance funds are in relatively good financial shape at the moment, but the memory of the failure of several health insurance companies a good two years ago has not faded in most of them. The additional contributions played a significant role in the bankruptcy of City BKK and other health insurers at that time. The stricken cash registers had to raise these in order to deal with their financial difficulties. However, the charging of the additional contributions led to numerous insured persons switching to another health insurance company without an additional contribution. Young, healthy, and relatively well-earning insureds were lost to health insurance companies and the spending structure continued to deteriorate. In the end, sometimes only the way to bankruptcy remained. Since then, the primary goal of the health insurance companies has been to avoid collecting additional contributions, since otherwise a similarly fatal development is feared.

Savings course to avoid additional contributions
Since then, numerous health insurance companies have been pursuing a stricter austerity policy in order to avoid having to collect additional contributions. Benefits for insured persons are subject to stricter controls and are often not approved, reports the dpa news agency. In 2012, the legally insured had received negative notices on the services requested in hundreds of thousands of cases. For example, about 1.5 million reports from the MDK on medically determined incapacity for work were requested from the health insurance companies, with the incapacity for work being denied in 16 percent of the cases. In other words: According to the MDK, more than 200,000 people who were initially declared disabled by their doctor were able to continue working. In the rehabilitation measures examined by the MDK, the proportion of negative decisions was significantly higher. Of the 700,000 rehabilitation services examined, only 61 percent were confirmed as required by the MDK. In 39 percent of the cases, the experts did not see the medical requirements fulfilled. Two out of five people who hoped for rehab did not receive it. According to the “dpa”, the proportion of unauthorized cases for hearing aids was similarly high. 500,000 MDK reports were drawn up in this area, a negative decision followed in 37 percent of the cases.

Well-justified rejection of requested services?
The managing director of the medical service of the Federation of Health Insurance Funds, Dr. Peter Pick, has rejected the criticism of a supposedly tougher austerity policy of health insurance companies and made it clear that there has been a slight decline in the cases of incapacity for work, rehabilitation measures and approved aids since 2010. He also pointed out that it might make sense to reintegrate people with mental health problems into the world of work instead of declaring them unable to work. A high rejection rate was observed for the aids, but this does not mean that those affected remain unaffected. Because they would often receive other care instead of the originally intended services, which also served their purpose. In spite of this denial, the high proportion of rejected services suggests that not only medical aspects but also cost factors play a role here.

Submit objection to rejection of rehabilitation measures
The president of the social association VdK, Ulrike Mascher, sees the rejection of medical services such as rehab or a hearing aid application extremely critical. How high the actual need for rehabilitation measures was, for example, was shown by the fact that "despite all savings efforts and a very restrictive licensing practice, the German pension insurance exceeded the budget for occupational and medical rehabilitation benefits in 2012", explained Mascher in a press release at the end of July. The VdK knows from the advice that “many rehab applications are initially rejected. Only those who object can possibly get their turn. "

Counterproductive savings efforts by health insurers
The president of the VdK advocated the abolition of the capped budget for rehabilitation services, because the rehabilitation must be funded without restrictions. "Anyone who becomes permanently incapable of work due to illness or disability places a greater burden on the social system than those who can return to employment subject to social security contributions after rehabilitation," Mascher explained the advantages of comprehensive rehabilitation. According to the VdK, "it has long been proven that the costs of professional rehab can be recovered after only three to five years". Saving efforts in rehabilitation measures could therefore lead to financial advantages for health insurance companies in the short term, but could have considerable disadvantages in the long term. The tightened austerity measures of health insurance companies would therefore have an extremely counterproductive effect in the long term. (fp)

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