Basic PKV tariff: Doctors refuse treatment



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Basic PKV tariff: Doctors refuse to treat patients

Nationwide it happens time and again that patients with a basic tariff of private health insurers are rejected by doctors. Thereupon the parliamentary group of the left started a small inquiry to the federal government. This reflected in an answer, "these are rare individual cases". In principle, however, resident physicians are permitted to reject patient groups without giving reasons, as was further stated.

Apparently it happens again and again that doctors reject private patients because they only have a basic tariff of private health insurance (PKV). The basic tariff must be offered by all private insurers so that medical care for financially disadvantaged private patients is guaranteed. The tariff is based on the health benefits of the statutory health insurance companies. Therefore, there should actually be sufficient basic care.

Physicians can legally reject basic tariff patients
However, the Left Party is aware of numerous cases in which doctors rejected basic tariff patients. Therefore, the parliamentary group launched a small question to the Federal Government (printed matter 17/4782). The reply letter that the editorial office "Heilpraxisnet.de" is available contains around 50 responses from the federal government. In the text, the black-and-yellow coalition claims that only a few cases are known throughout Germany in which doctors or dentists actually refused treatment. However, the basic tariff does not automatically lead to an “immediate extension of the treatment obligation of the individual contract doctor or dentist to this patient group”. In plain language, this means that doctors are not subject to any legal obligation to actually treat the patient. The doctor does not even have to justify why he rejects the person concerned. The Federal Government has also made a clear statement on this. "A reason does not have to be given for the rejection," as the letter says succinctly.

Federal government rejects responsibility
It can also be read that the Federal Government cannot influence the current situation. The statutory health insurance associations were responsible for such questions. These have the mandate to "ensure the medical and dental care of basic tariff insured persons". Those affected should therefore contact the statutory health insurance association if they are rejected. These can then name contract doctors in the regional area. The doctors and dentists would also treat basic tariff patients. The Federal Government believes that the problem is relatively minor, so that political intervention is not considered. If necessary, the institutions can rely on the help of the supervisory authorities, the reasoned. Furthermore, there are only a few people who actually use the basic tariff. According to the Federal Ministry of Health, just over 20,000 people are affected by the basic tariff of the private health insurance. However, the number has almost doubled compared to the previous year. In 2009 there were only 13,000 insured.

The left sees a scandal in the process. The legislator is very much responsible for this. The health spokeswoman for the left, Martina Bunge, said: "The federal government is doing nothing about how thousands of citizens are poorly cared for." The federal government must finally take action.

None of the participants is able to answer exactly how high the numbers of the rejected “individual cases” are. However, it can be assumed that the basic tariff will be used by a far larger number of insured persons in the future. This can quickly turn into a mass phenomenon from an individual case. It remains to be seen whether politics can then escape responsibility. Until then, affected medical practices must be mediated by statutory health insurance associations. (sb)

Photo credit: Gerd Altmann / pixelio.de

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