Exchange of blows between minister and health insurers

Berlin Verbal exchange of blows between National Association of Statutory Health Insurance Funds and Federal Minister of Health at the summer party of the Health Insurance Association: The President of the National Association of Statutory Health Insurance Funds, Doris Pfeiffer, frontally attacked Federal Minister of Health Karl Lauterbach (SPD) for his policies.

I never tire of reminding you of the coalition agreement. The situation is difficult, but I would like you to be more committed to the policyholders, said Pfeiffer in the direction of Lauterbach, in view of the many laws that must be paid for mainly with policyholders’ contributions to the statutory health insurance system (GKV) .

A thorn in Pfeiffer’s side is the Hospital Care Improvement Act (KHVVG) transformation fund, half of which will be paid by the GKV worth €25 billion. Yes, the transformation costs something, which is at the service of all citizens, and no, half of this should not be borne by taxpayers, continued Pfeiffer.

The KHVVG had some positive approaches, but was overwhelmed in discussions for a year. As of today, it is a project with expensive measures. The same applies to the GVSG, which does not offer significant better care, but only supports general practitioners in urban areas.

From his point of view, the principle of economy must also be preserved in the healthcare system. You talk about defunding the healthcare system. We need more economic guidance that allows for efficiencies in the system, Pfeiffer said. Therefore, all laws go in the wrong direction.

She also didn’t care about the Healthy Heart Act bill that had just been introduced. Prevention was yesterday, today we’re going to the doctor, that’s how Pfeiffer described the intention. Prevention budgets are intentionally tight. Now prevention is also discretized. All prevention courses from health insurers are certified, there are binding measures and there are no marketing effects, Pfeiffer emphasized.

There is also clear criticism of the federal government’s plan to transfer essential competencies in the approval of medicines, prevention and preparation of anamnesis records under the Heart Law, away from self-administration and towards federal policy.

It is a step backwards if these skills are no longer present Federal Joint Committee lie, says Pfeiffer. The project is now a continuation of the long series of laws that are undermining the autonomous health system.

And I’m personally disappointed in them for not taking into account the principle of proof. They undermine the principles of self-government. “I wouldn’t have found this surprising with your predecessors in office, but I wouldn’t have expected it with you,” she concluded her speech to applause from those present from the autonomous government.

They supported her once again the next day at the GKV board meeting and praised Pfeiffer for her clear speech against the Minister of Health.

Lauterbach defends himself

Lauterbach did not passively accept the harsh criticism of his government’s actions. I think it’s good when you exchange ideas openly and clearly, you can’t just talk about it, he said at the beginning of his 15-minute response.

I am clearly in favor of self-government, even if we do something different here or there. The self-government system is the best system in Europe and must remain that way, the minister emphasized. But you have to see where the country is now. One might get the impression that self-management has worked well, committees are working, says Lauterbach.

The conclusion that a little more tax money would improve the revenue side and that there would then be time for major reforms is a fallacy. But the truth is: we don’t have revenue problems, we have significant quality problems and efficiency problems. They can only be solved if we place more emphasis on medical problems and do not believe that economics can solve them.

So your solution is: we are making very fundamental reforms that no longer follow the German solution of simply putting more tax money into the system and then everything remains as it was, Lauterbach continued. He thinks this is wrong.

Therefore, we have to start with prevention: of course it is simple and plausible to say that young people should do more sport, so they don’t need statins, says Lauterbach about his oversimplified plans to prescribe statins for children and young people.

But there are children who have a congenital lipid metabolism disease, they can play as much sport as they want and at 25 their blood vessels are as good as those at 80 years old. There must be solutions for them. If we take prevention seriously, we cannot replace prevention through medication with prevention through lifestyle.

Overall, the question arises as to why there are so many cardiovascular diseases in Germany. All I can say over and over is: eat healthier, go vegan, exercise more in class. But if I want to do this seriously, I have to consistently address blood pressure values ​​and lipid metabolism disorders, continued Lauterbach. This is not just a ministerial opinion or a betrayal of evidence-based medicine, but it also corresponds to guideline recommendations.

It is very common for evidence-based medicine to be implemented through self-administration. But it is not correct to say that there is only evidence-based medicine if self-administration has participated, Lauterbach continued, referring to the questions of to what extent self-administration is still involved in the law. We shouldn’t go that far. If, in this exceptional case, we take the evidence directly from science, we are doing it to save time, because I don’t want to waste any more time with young people.

Regarding the hospital reform, he defended the financing of the transformation fund: Of course, I would prefer if we had 25 billion in tax money for this. The truth is that we do not have the tax resources at the moment. During the negotiation of the coalition agreement, which you always remind me of, there was no war in Ukraine. If I postpone the reform now until there is money again, then we will do what we have always done: we will do the German system, we will put more and more money into the system, but little will change structurally. Lauterbach does not want that.

For the Medical Research Law (MFG), which according to information from the German medical journal Lauterbach indicated that some changes will be finalized in parliamentary deliberations and voted on in parliament next week.

Companies conducting research here should have an advantage when it comes to AMNOG pricing. I can already see their outcry about how these things can be combined. But in my opinion, this is a win-win situation. We are providing incentives to ensure that meaningful clinical research takes place again. From his point of view, Germany has clearly lagged behind as a place of study. This is also not a good sign for the European location.

Overall, he said the federal government is making reforms for patients. The Federal Minister of Finance is interested in the costs not being so high, I am interested in the offer being better. This also means that the high number of doctor-patient contacts that Lauterbach now estimates at one billion doctor contacts per year must be significantly reduced.

At the same time, there are long waiting times for specialists and psychotherapy: this is an issue where the self-government has made no progress without the minister’s help. As a first step, the quarterly flat fee for general practitioners will be abolished, digital options should help with everyday practice and Lauterbach intends to examine suggestions for specialist practices. © bee/aerzteblatt.de