Higher compensation payments: Health insurance companies make members sicker

Higher compensation payments: Health insurance companies make members sicker

 

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Tuesday, the 20.09.16, written by Annabell Meyer

The sicker, the more rewarding: By means of a financial compensation, health insurance companies benefit from chronically ill insured persons. The system should actually provide for a fair cost compensation. But some funds let their members of doctors diagnose common diseases and thus get more money than they deserve.

 

Kranke Versicherte bringen Krankenkassen Vorteile beim Finanzausgleich

Health insurance companies pay doctors for the diagnosis of common diseases

If health insurances have a particularly high number of older and sicker members than other insurers with more young and healthy insured persons, they receive a financial compensation through the so-called morbidity-oriented risk structure compensation (Morbi-RSA). Thus, fair competition between the funds is still possible. Since its introduction, however, the compensation procedure has been criticized for favoring certain funds. A report of the world on Sunday is now pouring more oil into the fire. According to this , some funds make their insured sicker than they actually are .

1,000 euros per patient: Health insurance companies benefit from widespread diseases

As the World is currently unveiling on Sunday, several health insurances have been paying premiums of more than 840 million euros per year for doctors to diagnose a common disease in their patients. As a result, the health insurance companies want to get a higher share of the financial equalization. Because ” for each member with a compensatory relevant widespread disease, the insurances receive supplements, on average, well over 1,000 euros per diagnosis, ” the newspaper explains. Sometimes even external service providers are hired, which should make the insured to go to the doctor. This then diagnoses diseases such as diabetes or obesity, so that the cost compensation for health insurance increases.

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What is the system of compensation between health insurance funds based on?

Basically, the Morbi-RSA has the task to reduce risk differences. Thus, the health insurance companies, which have higher costs for their patients, receive a larger share of membership fees and government subsidies . The amount of the payment depends on the age and sex of the insured as well as on whether they receive a pension for reduced earning capacity. In addition, the need for care of the members has been included as an example for 80 diseases in the last seven years. For example, if an insured person has one of these conditions, he has to undergo expensive treatments. For this his health insurance is compensated by the Morbi-RSA .

Too General and Preventive: Assignment Principle in Criticism

While health insurance funds such as the general local health insurance funds (AOK) welcome the allocation system and profit from it, resistance, guarantor and replacement health insurance funds encounter resistance. Some of them have even joined forces to form an RSA alliance. This criticizes that some providers are favored by the compensation process. Therefore, it requires an adaptation of the system. For example, regional factors should be included more in the calculation. Because often the treatment costs vary depending on the location. In urban areas, these are higher, but lower in rural areas. The list of 80 diseases also needs to be broadened . Currently, strokes or certain cancers are considered, but not sufficiently covered.

In addition, the existing compensation principle ensures that prevention offers are no longer worthwhile. ” Funds are systematically financially punished if they invest in prevention, ” says Hans Peter Wollseifer of the umbrella association of guild insurances. The AOK-Bundesverband contradicts these allegations, however, and points out that the compensation system was “never fairer than today”. Even the Federal Ministry of Health and the Federal Insurance Office see no acute need for action.