Mr Knieps, in Germany, must wait for severely ill patients for years on the decision of whether your health insurance provider must pay a treatment or not. This is in order?
We had a process where only after eight or ten years, it was decided. This is clearly too long, normally it goes faster. If there is evidence that a new examination and treatment methods have tangible benefits for the legally Insured, they come into the service catalog. If this can not be substantiated, it is true, no joint and several means to spend for it.
the Minister of health, Jens Spahn wants to, if necessary, are single-handedly about what treatment is covered by health insurance…
I think nothing. The decision to Fund benefits is the task of the joint self-administration, and evaluated according to accepted rules of evidence-based medicine. It must remain so. In the Ministry of the property, not sitting even mind. In addition, a Ministry is subjected to significantly stronger the influence of lobby forces.
self-management, with the Common Federal Committee decides, by consensus and according to strict scientific criteria. This procedure is too cumbersome?
It is sometimes cumbersome, laborious and slow. If you have to scrape together what is scientific knowledge in the world can take. However, I think it is time well spent. And as a rule it is not. A quick access in urgent cases, you can talk to.
it Is not good to have a Minister of health, the encrusted structures breaking up?
It is good to have a strong Minister of health. Also, the durchfegt in the health care system changes. But if you are not careful, there are in this purely to make shards. This danger should note Jens Spahn.
for the First time properly on the feet Spahn of self-management is entered with the default, in hospitals, a minimum ratio of nurses to provide. Was not entitled to?
It was entitled that the policy has interfered. The fact is: We have been looking the other way for the care in the hospitals too long and too little for us, thus, that the case had a flat there for ever-greater economies of scale in the care. At the Doctors it was different, had enough to fight back lobby power against unwanted developments. Whether it is right, therefore, the whole case flat-rate system in question, how does the coalition now, I venture to doubt.
Also in contention for the electronic health card, Spahn makes steam. He wants to make his Ministry now, with the 51 percent majority shareholder of the operating company Gematik. It needs this pressure, because of the progress in digitisation so hard ?
It takes pressure of the political leaders that we come in the digitization finally manageable applications. The way to dispossess us of the Gematik and to take on the operational management, poses for Mr Spahn but great risks. And I have the impression that we are in the electronic patient file, the to 1.January 2021, all Insured persons should be available, now only one type of wooden craft model, in order to fulfil formal obligations. And that we will be an embarrassment to us internationally.
Spahn comes with one law after the other. We really have such a backlog of reforms, or much of it is just activism?
Difficult. I think a lot of things for in need of reform. But the devil is in the Detail. And you can’t distribute with populism. The only step-by-step by careful legislative work, the need to grab a small piece wheels work together, eliminate. If Mr. Spahn pounding with the foot, this changes nothing in the German health care system.
What is it exactly that you find populist attempts at Spahns?
Such practices to its requirements for longer opening Hours of the doctor. It is clear that there is no physician work only 20 hours, but on average far more than 40 hours per week. The bubbles populist. The underlying problems of false incentives in the remuneration system, and a bad Interaction between outpatient and inpatient care, but will not be addressed. Because you would have to create it not only with cash doctors, but also with clinics and the involved States.
On Thursday Spahn has released his long-planned law to better appointment and care of NHS patients through Parliament. But it is also full of short-Packed new regulations, which have to do with the origin of the concerns of the law. What do you think, as a former head of Department in the Ministry of health of this action?
Also, we have Ulla Schmidt for the sake of simplicity ever Packed on ongoing legislative procedures. But from the quantity to the now very different dimensions. We would not have the courage, just the most difficult and most controversial passages to bring in only the second or third reading by Amendment. Or even those with which you previously failed.
The Problem with such a thick Omnibus legislation is that in the end hardly anyone knows what is all in there. Is it legitimate to keep the transparency so?
From my point of view, such a law overtax procedures the members. I think the method that has been practiced Jens Spahn at the time of his appointment, service and supply act, to be legally dubious. Legitimacy results from the process. It is a shady and full of trickery, is also the legitimacy of the result in question. It amazes me that the majority in Parliament, the and not more revolted.
What you criticize at Spahns law work?
He practiced legislation in the hallway. Amendments there are virtually on demand. Affected associations have extremely little time to take a position. The opinions will be largely ignored – and the journey continues. A member of Parliament but must have the ability to opinions. He must also be able to ask the Scientific service of the Bundestag, if he has doubts as to whether a measure is compliant with the Constitution, or whether they conveyed the desired result. In such a procedure is not possible. And this undermines its legitimacy.
Packs Spahn so much in its laws, because he is afraid that the coalition will fly apart soon? Or do you see method in order to delicate things better to get through?
From my point of view it is a political tactic. Spahn is an active Minister with the idea of the matter. He wants to put the Participants under pressure and show who is the master of the house. The healthcare industry is highly complex. The processes take. And if a new regulation is in the Federal law Gazette, it does not mean that it works in practice the way the Minister imagines.
Spahn is also pushing the fact that the health insurance companies to reduce their financial reserves, and the contributors of the Surplus to benefit. What bad would it?
there is nothing per se bad. However, the regulations, the power of Spahn now equally fit for all, not to smaller funds. The can get a single, extremely expensive case, such as a bleeder or a difficult type of cancer, and the reserve, which is Spahn them, is consumed in a few months. I think this is short-sighted. The statement of Spahn that health insurance companies are not savings banks, I think it’s right. And to do something about it, that in the case of certain funds due to errors in the risk structure compensation assets accumulate, is also in order.
a process of concentration Would not be conducive? What is the need of so many small funds?
In the case of small funds, especially when you are only one company in charge, is health insurance part of the company social policy. And what business is it of the policy, as many insurance companies do we have? The Insured benefit from the competition. They are already voting with their feet about whether they want to keep their small company health insurance or not. And even if small funds, can not afford for perhaps as much as the Large ones: In Alliance with each other you can.
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Minister of health, Jens Spahn His concept of the taboo
Rainer Woratschka
Franz Knieps is a Board member of the Federation of company health insurance funds. Before. from 2003 to 2009, was a lawyer, head of Department for health, policy and “grey Eminence” in the Ministry of health, Ulla Schmidt (SPD).
