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Health costs rise in Germany

After a period of cautious prescribing, with a low point in 1993, doctors are now tending to prescribe more and, particularly in eastern Germany, more expensive drugs. The rise in drug costs has also been aggravated by the government's abandonment last year--following heavy pressure from the pharmaceutical industry--of a "positive list" which was intended to set price limits for standard drugs. As a result drug costs have only fallen 0.2% during the last year.

In addition, experts already predict that restrictions by health insurance companies for hospital treatment, spa cures, glasses, and dental treatment, which will come into effect in 1997, will probably not be as cost effective as initially expected. And doctors are protesting against German health minister Horst Seehofer's plans to pay family doctors quarterly from next year rather than on a fee for service basis.

The conflict between the health minister and the health insurance industry is escalating daily. Earlier this year Mr Seehofer said that health insurance contributions should be cut by 0.4% by 1 January 1997. But health insurance companies have just announced that contributions will rise by up to 1% or some may face bankruptcy because they are unable to absorb the rising drug costs.

Mr Seehofer hit back by saying that health insurance companies had brought misfortune on themselves by increasingly making costly offers such as free gymnastics, yoga, or diet consultations to attract new members. He has threatened to put a freeze on health insurance contributions for several years to come if companies insist on going ahead with such rises. This would be the first time the government has intervened in such a way in the history of the public health insurance system in Germany.

Not unexpectedly the largest insurance company, Allgemeine Ortskrankenkasse, sharply rebuffed the idea. "This would shake our liberal health care system down to the foundations," said Peter Kirch, administrative director of the group, and called Mr Seehofer's thrust an "outrage."

Herbert Rebscher, board director of the association of employees' insurance group (Verband der Angestellten-Krankenkassen), said that the initiative would mean "the abandonment of all concepts in health policy worked out in recent years." He said that freezing insurance contributions for years would inevitably lead to a further reduction in health insurance services.

However, none of the critics questioned whether Mr Seehofer's intervention would be constitutional or not or was planning any legal action against it.--HELMUT L KARCHER, medical writer, Munich

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