Private medicine: essential support for registered doctors
In comparison to the statutory health insurance, private health insurance has to dig deep into its pockets to meet the claims of their clients. The system relevance of the private health insurance is confirmed by a recent survey.
COLOGNE. Registered doctors have earned additional Euro 50,200 in 2015, states a recent analysis of the Wissenschaftliches Institut der PKV (WIP). This is due to the higher professional fee doctors receive for treating privately insured patients. The institute estimates a plus in business - private fee minus EBM reward for similar treatment - in the ambulant medical provision of Euro 6.1 billions. The effect is even greater in the business of dentists. Their offices benefit from a plus of Euro 61,900 on average. For medicine suppliers, privately insured patients brought in at least Euros 15,600 more than expected. "This shows the elementary meaning of the privately insured patients for the existance of the medical infrastructure", say authors Sonja Hagemeister and Dr. Frank Wild in their analysis.
Ammunition for campaign
The plus in business is named by the WIP as the amount that is aditionally available to providers through the existance of private health insurance. The institute calculates the value by comparing the salaries paid by private health insurance to the salaries which would have been paid by the statutory health insurance for the very same patients. "These additional funds enable investments for the medical infrastructure, for research of new methods of treatment and for hiring new medical professionals."
The institute examines the plus in business since many years. It surely is no coincidence that the evaluation for 2015 happens only 6 months after the <link http: www.aerztezeitung.de praxis_wirtschaft w_specials special-versicherungen article external-link-new-window internal link in current>evaluation for 2014 - fitting for the German national election campaign with the federal election coming up this autumn. Three parties - Social Democratic Party of Germany (SPD), Green Party and Left Party - list a national health insurance scheme in their election programme. "Political suggestions concerning health issues that downgrade the importance of private health insurance in the German health system would have negative effects for the providers of health performances and for their statutory and privately insured patients", state Hagemeister and Wild.
Researchers show a plus in business in 2015 of Euro 12.6 billion for all areas of medical performance which was 1.4 per cent more than in 2014. "Expenses for aids and appliances (9.8 per cent), surgical dressings and pharmaceuticals (5.6 per cent) register the highest procental rise." The ambulant medical care and the in-patient branch as both being the largest performance sectors have only risen by 1.2 per cent and by 0.6 per cent.
The plus in business in the ambulant medical care is not referable to the differences between the medical fee schedule and the EBM. Apparently, also the instruments for limiting expenses and quantities within the statutory health insurance are visible in the effects, naming pausibility checks and efficiency audits as well as standard benefit values.
The authors explain further that the regulation of performance expenses within the private health insurance happens only via the private law insurance agreement. Limitations are only visible through guidelines of single positions of the medical fee schedule and in the limited applicability of increase factors. Further quantity limitations would not exist. "Therefore the doctor is free in diagnosing and deciding for therapy options during private medical care billing as long as medical necessity and billing terms are adhered to."
Private health insurance pays more for ambulant medical care
Hagemeister and Wild point out that due to different classification in the ambulant medical care a quantity effect can be assumed. Doctors would also have motivations to keep privatly insured patients longer in ambulant medical treatment and hospitalise them later, which is mostly in the interest of the patients. They emphasize that there is no empirical evidence for a delayed hospitalisation. "An evidence for this thesis is however that there is a higher rate of ambulant medical care among privatey insured patients in comparison to the in-patient area while for statutory health insurance it is vice versa."
In 2015, private health insurance spent Euro 10.7 billion for ambulant medical treatment, for in-patient treatment Euro 9.2 billion. According to the WIP, this plus in business amounted to Euro 693 million.
In 2015, registered doctors could earn a plus in business of Euro 6.1 billion through treating privately insured patients - on average Euro 50,200 per office. This is the result of a recent analysis by the Wissenschaftliches Institut der PKV (WIP).
