Doctors warn health insurance savings law could hit pregnancy screenings

Doctors have warned that a German law aimed at closing a multibillion-euro deficit in statutory health insurance could limit access to pregnancy and cancer screening. BR reported Friday that some medical services will no longer be reimbursed under the same conditions as before.

Charlotte Simon-Zuber, who took over a gynaecology practice in Munich’s Au district in July, said the law would mean she could provide important preventive examinations to fewer patients. These examinations were previously classified as extra-budgetary services, meaning specialists received full reimbursement without a limit.

The contribution rate stabilisation law says such services account for a steadily increasing share of statutory health insurance spending and have contributed significantly to rising costs in outpatient care. Under the new rules, doctors will face reduced reimbursement for more services if they bill them too frequently within a quarter. They would therefore earn less for providing those services despite rising rent, staffing and material costs.

Simon-Zuber said the changes could threaten the financial viability of her recently acquired practice. According to the Bavarian Association of Statutory Health Insurance Physicians, extra-budgetary payments currently account for about 60 percent of gynaecologists’ income in Bavaria.

She said the issue was also about patient care, particularly cancer and pregnancy screenings. Under the maternity guidelines of the Federal Joint Committee, which legally determines the benefits available to around 74 million people with statutory health insurance, pregnant women are generally entitled to a check-up every four weeks.

If women had to wait weeks for an appointment because practices lacked capacity, their care would be at risk, Simon-Zuber said. “Pregnant women cannot wait,” she added.

Andreas Beivers, a health economist at Fresenius University of Applied Sciences in Munich, said the law created a risk that some patients would no longer receive appropriate care or would be moved into the next quarter. He said this could happen with less urgent examinations.

Doctors were being placed in a difficult position, Beivers said: They had to decide whether to carry out an examination for less money in the patient’s interest or refuse it because it was no longer financially viable. He did not expect the changes to lead to widespread practice closures.