Orthopedic technicians criticize blanket cuts to aids

The German government is planning a flat-rate reduction of three percent in the reimbursement for assistive devices for the years 2027 and 2028 with the Statutory Health Insurance Contribution Rate Stabilization Act. The Federal Guild Association for Orthopedic Technology argues that this sends the wrong signal.

The German government aims to improve the precarious financial situation of statutory health insurance funds (GKV) and will introduce the GKV Contribution Rate Stabilization Act to this end. A draft bill from the Ministry of Health has now been presented. The reform is intended to more closely link expenditures to revenues. According to the Ministry, this would make contributions more predictable, socially equitable, and ensure they remain virtually constant over the coming years. With this package of measures, the government is focusing on reducing the rate of increase in GKV expenditures.

"In the future, the efficient and targeted use of contribution funds in all areas of the healthcare system will be essential," the draft legislation states. It continues: "The very high increases in remuneration across all areas of the healthcare system over the past five to seven years will be limited to a level that corresponds to wage and income growth in the overall economy and simultaneously strengthens remuneration equity between sectors." The aim is to maintain the level of services and the quality of care.

Wrong signal regarding economic policy

A measure is causing discontent among orthopaedic technicians. For assistive device fittings in 2027 and 2028, the contractually agreed remuneration is to be reduced by a flat three percent per fitting. The Federal Guild Association for Orthopaedic Technology criticizes this as being contradictory from a regulatory policy perspective and sending the wrong signal to a sector that has not been moving away from the revenue side. According to the guild association, this measure represents government intervention in a sector that is not characterized by decoupled price dynamics.

A particularly problematic aspect is that the proposed fixed amounts "explicitly target standardized care sectors with a low service component, while the across-the-board reduction has entirely different effects." It treats unequal care situations equally, thus creating unequal burdens. "Standardized sectors are relatively favored, while service-intensive care sectors are disproportionately burdened. Those most affected are labor-intensive, craft-based, and community-based structures that are indispensable for complex care."

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Consider orthotic and prosthetic care

The draft law thus weakens areas needed for outpatient care, participation, and relieving the burden on the clinical sector. At the same time, it increases the risk in areas of care where under- and inappropriate provision already cause high follow-up costs. "Legally sound, transparent fixed amounts can be a useful instrument in the assistive device sector if they are geared towards standardized care areas and accurately reflect the reality of care provision. The basic logic behind dynamic co-payments is also understandable."

It is unacceptable, however, that service providers in the assistive devices sector continue to bear the unilateral risk of non-payment. "As long as this disadvantage persists, the co-payment effectively acts as an additional reduction in benefits. Similarly, a second opinion procedure before high-volume procedures such as knee replacement is generally advisable. However, it remains incomplete if conservative treatment options are not included early and in a binding manner." Anyone who wants to reconcile cost-effectiveness and quality must systematically consider orthotic and prosthetic care and other conservative measures before surgical interventions.

Stabilize statutory health insurance permanently

The problem lies not in cost-effectiveness management, but in the cuts to a sector that already operates with discipline and is essential for efficient, local, and patient-centered care. "Anyone who wants to unlock savings potential in the assistive devices sector must focus on structural reforms instead of across-the-board cuts: less bureaucracy, less contract complexity, more digitalization, and more standardization." The trade association therefore demands that the cuts in the assistive devices sector be reversed and replaced with differentiated cost-effectiveness management and structural reforms that ensure supply, relieve the burden on skilled workers, and provide long-term stability to the statutory health insurance system.

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