“Some insurers really hunt for chronic ill patients,” Leonard Hansen, head of the health insurance association Nordrhein told the paper.
One of the country’s biggest health care providers, AOK in Lower Saxony, is systematically sending staff out to check up on surgeries across the country to ensure the doctors enter certain long-term illnesses in the patient files. If a patient with high blood sugar is classified as “diabetic with complications” the AOK gets €169 more in payment from the health funds. This is also lucrative for doctors, who get €10 for every patient file the insurance provider checks.
Health insurers in the state of North Rhine-Westphalia are actively prowling for super sick customers as well, claiming there is still room for “improvement.”
“We are trying to increase our potential for optimization,” a spokesperson of the social miners’ insurance provider told the paper without going into detail.
“The healthy ill patients” are especially interesting according to Hansen because they bring in high benefits but create below average costs for insurers. But neither the patients nor doctors would benefit from an ostensible illness. Ultimately insurers come out on top, Hansen criticized. Health care reforms in general don’t usually lead to better care for the patients, he said. “[The money] should go into the treatment,” he said.
Insurer AOK Rhineland-Hamburg rejected the dubious action. “We don’t pay the doctors more money for administrative work they will have to do anyway,” director Wilfried Jacobs told the Rheinische Post, adding that such action would be illegitimate and unethical. The new campaign is simply a matter of showing doctors how to properly encode patient files.
The new reform is meant to equalize finances between different health insurance providers. Previous structure was based on the health risks depending on age, sex and income. But as of 2009, structures will be based on customers’ state of health.