FW: Patients fined for not following doctor's orders

[Guest guest]

From: AVN

Sent: Friday, January 11, 2008 11:02 AM

Subject: Patients fined for not following doctor's orders

BMJ 2008;336:65 (12 January), doi:10.1136/bmj.39454.429931.4E

http://www.bmj.com/cgi/content/full/336/7635/65

News

German patients escape financial penalties for not following their doctor’s

advice

Annette Tufts

1 Heidelberg

Patients with chronic disease in Germany will now be penalised only if they

explicitly declare that they have not taken drugs and followed their doctor’s

advice and will continue doing this in the future.

The government originally wanted to impose financial penalties on any patient

who did not follow medical advice. But the plan was abandoned after doctors and

patient groups mounted vigorous protests, saying that it would destroy the

doctor-patient relationship. The legality and ethics of the plan were also

questioned.

The compromise was reached just before Christmas by the federal joint committee

of doctors, hospitals, and health insurance companies (Gemeinsame

Bundesausschuss), which informs government decisions on the refunding of health

care costs. The ruling took effect at the start of this month.

" A legally sound regulation on therapy compliance has to be based on an

agreement between doctor and patient, " explained the chairman of the Gemeinsame

Bundesausschuss, Rainer Hess.

Doctors will now have to certify that all patients with long term conditions are

sticking to their treatment unless the patient refuses the treatment. The

certificate will limit a patient’s contribution towards health care costs to a

maximum of 1% of their gross income. Patients without a certificate will pay 2%.

Exemptions to the new ruling include children under 18, people with severe

mental or physical disabilities, and patients needing nursing care, who

automatically qualify for the lower contribution level.

A similar plan in July 2007 to make breast, bowel, and cervical cancer screening

compulsory and penalise those failing to attend was also dropped by the

Gemeinsame Bundesausschuss (BMJ 2007;333:877).

Instead, the committee decided to make an explanation of the risks and benefits

of screening compulsory. All women born after 1 April 1987 and all men born

after 1 April 1962 without private insurance will have to certify in a health

check-up passport that they have received counselling. The certificate will

enable them to claim an additional refund of health care costs should they

develop any of these cancers. The younger age for women takes account of

cervical screening.

" We could not decide on any stricter regulation and force patients to take part

in screening tests since all of them carry risks as well as benefits " , said Dr

Hess.

Currently, all adults over 55 are advised to undergo faecal occult blood testing

for colon cancer every two years and colonoscopy twice, 10 years apart. Men are

advised to have an annual rectal examination for prostate cancer once they reach

45, and women are recommended to have annual check-ups for breast cancer from

the age of 30, mammography every two years between the ages of 50 and 69, and

cervical smear tests annually from the age of 20.

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.17.13/1212 - Release Date: 6/01/2008

10:55 PM

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.17.13/1212 - Release Date: 6/01/2008

10:55 PM

[Guest guest]

My chiro just told me of a man who didn't follow his doctor's orders

regarding high blood pressure medicine (or high cholesterol, not sure) and

the doctor told the insurance company. The insurance company told the man

that if he didn't follow the doctor's advice, they would cancel his

insurance. I had no idea this could happen. Land of the free? Apparently

not.

Trish

FW: Patients fined for not following doctor's orders