Medical aid provision: reducing bureaucracy instead of regulatory fantasies

The alliance "We provide for Germany" rejects the demands of the GKV-Spitzenverband for more regulation in the provision of medical aids.

This article is part of the special topic Bureaucratic madness in the craft industry

Insured persons of the statutory health insurance companies (GKV) are entitled to a additional free care with medically necessary aids such as hearing aids, walking aids, prostheses or bandages. The health insurance company covers the costs for the medically necessary and most economical aidsThose with statutory health insurance must contribute a co-payment of at least five and a maximum of ten euros. Additional costs for extras, for example, for aesthetic or comfort reasons, must be paid by the insured person themselves.

The National Association of Statutory Health Insurance Funds evaluates the billing data for aids every year and presents the results in its Report on the development of additional costs for the provision of assistive devices The data for last year are now available. "80 percent of medical aids are free of charge for statutory health insurance policyholders," explains Doris Pfeiffer, Chairwoman of the GKV-Spitzenverband. "In the reporting year 2023, GKV insured persons paid an average 149 euros in additional costs out of their own pocket. But are these additional costs justified and do they result in better care?" is their question.

Statutory health insurance companies demand mandatory reporting

Additional cost reportHere you will find the Report on the development of additional costs for the provision of assistive devices of the GKV-Spitzenverband.She calls for a statutory obligation to report reasons for additional costs: "Only when the health insurance companies know the reasons for this will it be possible to protect insured persons even better unjustified additional costs to protect." According to the umbrella association, most cases with high average additional costs are in health-related craft sector such as hearing aids or orthopedics. According to the association, orthopedic insoles the largest share of additional cost cases In addition, the benefit expenditure per pension case over several years increased significantly.

In contrast, additional costs in other submarkets of medical aids played a more minor role. To ensure that insured persons are not "to expensive, excessive supplies" pressured or inadequately advised about their entitlement to benefits, be more transparency about the reasons for additional costs. This requires the required reporting requirement. "Health insurance companies should know why insured persons choose aids that deviate from standard care and thus lead to additional costs to lead."

WvD criticizes heavily

The Alliance "We supply Germany" (WvD), which also includes the Federal Guild Association for Orthopedic Technology heard, practices harsh criticism on the proposal of the GKV-Spitzenverband: "Once again, the GKV-Spitzenverband is using the publication of the additional cost report to absurd demands for further justification requirements for additional cost agreements Pseudo-problems to fight instead of finally facing the reducing bureaucracy in care."

In view of the figures in the new additional cost report of the umbrella association, the renewed calls for a further increase in the already excessive bureaucracy in the provision of medical aids not to understandThe association itself states that 80 percent of the aids are provided without additional costs and that the quota have remained constant for yearsAt the same time, the additional costs for medical aids in the medical supply sector are almost consistently less than five percent of the total additional costs.

Reduction of bureaucracy called for

That is no reasonto derive a need for action in the area of ​​additional costs that goes beyond the existing consultation and documentation obligations. The WvD General Secretaries Kirsten Abel and Patrick Grunau explain: "Instead of dealing with pseudo-problems and ever new regulatory fantasies It would be urgently necessary for the GKV umbrella association to dedicate itself to reducing the completely excessive bureaucracy in the field of medical aids."

In over 1.000 individual contracts in the provision of medical aids, the health insurance companies have a "Jungle of regulations" accumulated, which on the part of the health insurance funds and the service providers without added value This wastes time spent on care, thus wasting insured persons' money. "This would be a worthwhile area for simplification in the interests of care, for which we would be happy to serve as a contact for the GKV-Spitzenverband."

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