BMG is alienating self-government with the Healthy Heart Act

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Written By Kampretz Bianca

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Berlin With the Healthy Heart Act, the Federal Ministry of Health (BMG) combat cardiovascular disease and, in doing so, accept a major conflict with self-administration. According to the bill that… German medical journal is available, preventive examinations scheduled for children and young people, as well as check-ups at 25, 35 and 50 years of age must be accompanied, among others, by questionnaires prepared by the Federal Ministry of Health itself. Legal regulation is provided for in each case .

To date, the Joint Federal Committee (G-BA) responsible. BMG also wants to define guidelines for the remuneration of these new exams, a task that would otherwise fall to the expanded evaluation committee of the National Association of Statutory Health Insurance Doctors (KBV), health insurance companies and impartial members.

Expanding statin prescriptions

Furthermore, according to the law, the prescription of statins should be significantly expanded, contrary to previous guidelines. Both guidelines from the German Society of Cardiology (DGK), as well as the guidelines of the German Society for General Medicine (DEGAM) provide statin therapy depending on cardiovascular event risk and LDL cholesterol level. People with familial hypercholesterolmia are already considered high-risk patients, which is why drug therapy is recommended even if cholesterol levels are lower. Doctors should now be able to prescribe statins early in cases of familial hypercholesterolemia. The bill does not yet provide more precise information on limit values.

As a rule, health insurers must invite children and young people between the ages of twelve and 14 to take the J1 exam. There will also be discussions on prevention on the topic of smoking and information on HPV vaccination. The aim is to increase the low participation rates in the J1 exam.

The new law also aims to fill the gap in early childhood screenings: although the current guideline calls for family history to be taken in the U1-3 exams, this is not the case in the J1 exam and there is a lack of explicit questions to identify sudden cardiac death.

However, the G-BA guidelines for examining young people already provide for a differentiated anamnesis and a clinical-physical examination, which most doctors must also include the family anamnesis. However, the G-BA guidelines do not yet contain a standardized questionnaire to record cardiovascular risk.

Vouchers for check-ups

Health insurers must also send invitations for check-ups to people aged 25, 35 and 50. Vouchers should also be included with which consultations and blood pressure measurements can be carried out, as well as measurements of risk factors for diabetes in pharmacies. Standardized questionnaires and parameters for laboratory testing must also be regulated by legal regulation and not by self-administration, as was previously the case.

The law also includes an expansion of drug therapy for smoking cessation: In future, the insured’s claim will no longer be funded only in the case of severe tobacco dependence, but also more frequently than every three years.

The law is causing clear criticism among health insurers and doctors. The Healthy Heart Act bill could also be called the Pills Instead of Prevention Act, explains Carola Reimann, President of the AOK Federal Association. The proposal for widespread use of screening and statins in children and young people goes in completely the wrong direction.

Statins are not smart, such decisions must be made based on scientific evidence through the evaluation methods established by the Federal Joint Committee, continued Reimann. It is a problematic narrowing of perspective when lifestyle issues are pushed into medicine and children are turned into chronically ill patients.

The federal presidents of the Association of General Practitioners (High voltage), Nicola Buhlinger-Gpfarth and Markus Beier, highlighted that the healthcare system urgently needs to catch up when it comes to preventing cardiovascular diseases and their consequences. However, the Healthy Heart Law is the wrong approach.

We clearly reject more and more testing and administering medications using a one-size-fits-all approach. The principle applied here: “A lot goes a long way” is more than dubious from a medical point of view, especially because the evidence is very scarce, according to Buhlinger-Gpfarth and Beier. Especially for younger people, comprehensive screenings, which can result in lifelong medication, should be used with extreme caution and always only on an evidence-based basis.

Interference in medical actions

However, targeted use of statins makes sense and is important, but it is always an individual decision between the doctor and the patient. It is therefore very strange how detailed the legislator wants to intervene in specific medical actions.

The plans announced by Federal Minister of Health Lauterbach contained positive approaches, but a truly consistent implementation of the idea of ​​prevention was lacking, criticized Andreas Gassen, Chairman of the Board of the National Association of Statutory Health Insurance Doctors (KBV).

It has to start with campaigns in schools so that children learn to lead a healthier life. Because they are the heart patients of tomorrow, says Gassen. © bee/me/aerzteblatt.de

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