Medical Association sees "self-destruction" of the PKV

Medical Association sees

The Vice President of the Medical Association sees "self-destruction" of private health insurance (PKV)

The rising expenditures for health services are also causing more and more problems for private health insurance companies. In order not to have to raise premiums further, private insurers are increasingly trying to limit the escalating costs. They received support from the black and yellow federal government and in particular from the Federal Minister of Health Philipp Rösler (FDP). As part of the health care reform, the PKV has been granted a number of concessions that will strengthen its competitive position in the future. But with the concessions in the direction of the PKV, the criticism of the additional demands of the PKV grew.

The simplified switch between statutory health insurance (SHI) and private health insurance, the ban on supplementary insurance with SHI and the expansion of drug discounts are examples from health care reform that significantly strengthen the position of private health insurance - often at the expense of SHI. And so criticism grows in the professional world. In view of the current measurement of strength between the private health insurance and the medical profession regarding the new regulation of the fee schedule, Frank Ulrich Montgomery, Vice President of the German Medical Association, took the opportunity to offer private health insurers and private health insurers a Association accused of offering an "impressive spectacle of self-destruction". The claims of the private health insurance system would amount to a “statutory health insurance system” and, if successful, would constitute the death blow for private insurers, the representative of the medical profession explained.

While lower costs, higher benefits and better service have always been used as arguments for private health insurance, Frank Ulrich Montgomery can no longer accept this argument. The Vice President of the German Medical Association explained that the lower costs can no longer be used as an argument if the private health insurance company now continuously demands benefits similar to those of the statutory health insurance system because of the cost explosion. Private patients would actually receive better service, but primarily because the private health insurance company agreed higher billing rates with the doctors than the statutory health insurance. This freedom of contract offers a decisive advantage over the GKV, said Frank Ulrich Montgomery. Thanks to the fee schedule, doctors earn more money on private patients, even with identical services, and are therefore willing to provide better service. If this schedule of charges is now undermined by the “opening clause” sought by the PKV and the comfort tariffs are cut in order to save costs, the question arises: “On what grounds does the PKV expect even faster and more convenient service?” Explained Montgomery . At the end of his article, the Vice President of the German Medical Association points out that he does not fail to recognize that for many insured people, the private health insurance system with its quick appointment and separate waiting room is a "feel-good product". But in his view, there is no reason to regulate this through the detour of different payment according to the fee schedule.

This also makes it clearer what Montgomery is actually about: the “opening clause” sought by the private health insurance companies in the reform of the Medical Fee Schedule (GOÄ) for billing medical services in the coming year. While the PKV wants to have the opportunity to individually negotiate with the doctors about the services and the associated costs, the doctors are strongly opposed to such a weakening of the existing GOÄ. With the allegations now expressed, the strengthening in the run-up to the reform is now in the second round. Last week, the PKV had accused the medical profession of "de facto advocating a state ban on negotiations", which "nobody would have expected from a liberal profession". The tone of the discussion becomes rougher, the content becomes shallower. It remains to be seen how the Federal Government will decide on the urgently needed reform of the GOÄ in the coming year. (fp)

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Image: Gerd Altmann / Gerold Meiners /

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