No more prevention courses and system breakdown: many criticisms continue…

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Written By Rivera Claudia

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Berlin Shortly before the private hearing of the associations on the Healthy Heart Act (GHG) next Monday, criticism of the project comes from the Federal Ministry of Health (BMG) not turned off.

This is how the National Association of Statutory Health Insurance Physicians sees things (KBV), like this many other organizations of the healthcare system, a systemic rupture of the law: Here the legally anchored quality and cost-effectiveness requirements are being undermined, write the three KBV board members Andreas Gassen, Stefan Hofmeister and Sibylle Steiner in a statement on the law.

It should be rejected that doctors offer statins as cholesterol or lipid-lowering drugs to large sections of the population, in a rather uncritical manner, especially to children. These are very effective drugs, but some have significant potential for side effects, according to the KBV advice.

The right place in the German healthcare system to discuss therapies, drugs and examination methods is the Federal Joint Committee (G-BA). But he will be allowed to leave.

Doctor’s appointments are medicine

The KBV also speaks out against the expansion of health advice in pharmacies. This is the wrong way to go. Because: Occasional cholesterol, sugar or blood pressure measurements are one thing. However, medical advice is indisputably medicine. And medicine is reserved for doctors, according to Gassen, Hofmeister and Steiner. They are calling for these passages to be deleted from the law.

KBV executives also see some light in the bill: the topic of prevention and early detection of cardiovascular diseases is addressed through regular check-ups.

However, there is a lack of consistent implementation of the idea of ​​prevention to combat certain risk factors, such as smoking, high blood pressure, obesity or lack of exercise, through a change in lifestyle, sport or a different diet, according to the KBV.

Another positive aspect of the law is that new regulations for disease management programs (DMPs) should now arrive and be expedited. However, it would make sense to ensure that patients are required to cooperate for DMPs to remain effective, according to the KBV.

Several large statutory health insurance associations (GKV) are also very critical and, in a joint letter, criticize the use of prevention courses and the administration of medication.

Prescriptions for smoking cessation drugs, statin prescriptions, early detection and medical prevention recommendations should count towards funds available for primary prevention, council members and directors-general of the BKK umbrella organizationthe Association of Substitute Insurance Funds (vdek), in Federal Association AOK, the IKK eV, the miners’ association and the social insurance for agriculture, forestry and horticulture (SVLFG).

Quality-assured prevention courses have proven their worth

They are supported by a large number of sports and prevention associations, including the German Olympic Sports Confederation (DOSB), the German Sports Association for the Disabled (DBS) as well as the BAG Self-Help. Reducing prevention efforts is a completely wrong approach. Because: Quality-assured prevention courses are a proven and widely used tool to motivate and empower people to lead a healthy lifestyle and prevent diseases.

This is also confirmed by the draft law. Health insurance associations state that in 2023, 1.5 million people took part in prevention courses that would have been reimbursed by health insurance companies. This means that the available resources have been exhausted.

If this budget is now also used to finance cholesterol-lowering drugs, as well as expanding health check-up services and doctors’ fees, there will be little or no funds left to combat lifestyle-related causes, the health insurance associations write. This means that prevention recommendations issued by doctors would also be ineffective.

In addition, health insurance companies fear that the approximately 110,000 certified courses of more than 67,000 providers will be canceled. Much of this was done by the German Olympic Sports Confederation together with the Federal Medical Association (BK) developed. The needs, target groups, access routes, content, methodology, quality and scientific evaluation of prevention courses are not determined solely by health insurers, the letter continues.

They are carried out with knowledge in health sciences, medical and occupational medicine, psychotherapeutics, psychology, nursing, nutrition, sports, addiction, education and social sciences, as well as with knowledge of people with disabilities.

The letter has a wide range of recipients: According to the health insurers, it was sent to the ministers and state secretaries of five ministries, the Federal Chancellery, all parliamentary group leaders and their representatives in the Bundestag, as well as the chairmen of the responsible Bundestag committees on health, nutrition and agriculture, the environment, nature conservation and consumer protection, as well as the Committee on Family, Senior Citizens, Women and Youth. The members of the newly founded Expert Council for Health and Resilience of the Federal Chancellery also received the letter.

A positive assessment of part of the law comes from Afschin Gandjour, Professor of Health Management at the Frankfurt School of Finance and Management. He evaluated the Healthy Heart Act in a health economic calculation and came to the conclusion that around 32,000 cardiovascular events could be avoided with the planned options of additional statin prescription.

In Germany, there are around 500,000 strokes and heart attacks each year. According to his calculations, there are around 13.3 million people in the country who are at risk of a cardiovascular event within ten years. He estimates that the lifetime cost of strokes is around 90,000 euros and estimates that the cost of statins is 19 cents a day.

In addition, there are the necessary medical and laboratory costs of around 47 euros per year. This results in costs of 115.62 euros per year if a patient receives statins. With cardiovascular events prevented in this way, up to 1.2 billion euros per year in care costs could be avoided in the health system, according to Gandjour. © bee/aerzteblatt.de

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