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 feature on bureaucratic madness in the skilled trades.

Those insured under the statutory health insurance system (GKV) are entitled to free provision of medically necessary aids such as hearing aids, walking aids, prostheses, or bandages. The health insurance company covers the costs of the medically necessary and most economical aid . Those with statutory health insurance are required to contribute a co-payment of at least five and at most ten euros. Additional costs for extras, for example, for aesthetic or comfort reasons, must be paid by the insured themselves.

The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) analyzes billing data for assistive devices every year and presents the results in its report on the development of additional costs for assistive device provision . The data for the past year is now available. "80 percent of assistive devices are provided to those with statutory health insurance at no extra cost," explains Doris Pfeiffer , Chair of the Board of the GKV-Spitzenverband. "In the reporting year 2023, those with statutory health insurance paid an average of €149 in additional costs out of their own pockets. But are these additional costs justified and do they result in better care?" she asks.

Statutory health insurance companies demand mandatory reporting

Report on Additional Costs: Here you will find the report on the development of additional costs for assistive devices from the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). The association calls for a legal obligation to report the reasons for additional costs : "Only when health insurance funds also know the reasons for these costs will it be possible to better protect insured persons from unjustified additional costs ." According to the National Association, most cases with high average additional costs occur in the healthcare sector , such as hearing aid acoustics or orthopedics. The association states that orthopedic insoles account for the largest share of additional cost cases . Furthermore, the expenditure on benefits per case has increased significantly over the past several years.

In contrast, additional costs played a relatively minor role in other sub-markets of assistive device provision . To prevent insured individuals from being pressured by service providers into " expensive, excessive treatments " or receiving inadequate advice regarding their entitlements, greater transparency about the reasons for additional costs is necessary. This requires the proposed reporting obligation. "Health insurance companies should know why insured individuals choose assistive devices that deviate from standard care and thus lead to additional costs ."

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WvD criticizes heavily

The alliance " We supply Germany " (WvD), which also includes the Federal Guild Association for Orthopedic Technology , strongly criticizes the proposal of the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds): "Once again, the GKV-Spitzenverband is using the publication of the additional costs report to fight pseudo-problems with absurd demands for further justification requirements for additional cost agreements , instead of finally dedicating itself to reducing bureaucracy in healthcare."

In light of the figures in the new report on additional costs from the umbrella organization, the renewed calls for a further expansion of the already excessive bureaucracy in the provision of assistive devices are incomprehensible . The association itself states that 80 percent of assistive device supplies are provided without additional costs and that this rate has remained constant for years . At the same time, the additional costs for assistive device supplies provided by medical supply stores are almost always less than five percent of the total amount of all additional costs.

Reduction of bureaucracy called for

This is no reason to derive a need for action regarding additional costs beyond the existing consultation and documentation obligations. WvD General Secretaries Kirsten Abel and Patrick Grunau explain: "Instead of dealing with pseudo-problems and ever-new regulatory fantasies , it is urgently necessary for the National Association of Statutory Health Insurance Funds to dedicate itself to reducing the completely excessive bureaucracy in the area of ​​assistive devices."

In over 1.000 individual contracts for the provision of medical aids, health insurance funds have accumulated a " jungle of regulations ," particularly in the administrative area, which wastes valuable time and thus the money of the insured, without providing any added value for either the funds or the service providers . "This would be a worthwhile area for simplification to improve care, and we would be happy to serve as a contact point for the National Association of Statutory Health Insurance Funds."

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