Hospital.Help

Berlin Despite the slight about-face by the Federal Ministry of Health on the Healthy Heart Act (GHG), support for the project remains limited. The health insurance associations continue to describe the law as superfluous, while medical associations at least see the changes as no longer endangering the scientific evidence as a basis for decisions.

However, in their initial statements, all of them emphasize that the primary prevention of cardiovascular diseases must be given greater priority than previously envisaged.

Primary prevention begins with campaigns in schools, includes social education and considers, for example, advertising bans or high taxes on unhealthy foods, emphasized the National Association of Statutory Health Insurance Physicians (KBV) in an initial statement.

We still lack a consistent implementation of the prevention concept, say the three board members Andreas Gassen, Stefan Hofmeister and Sibylle Schneider. Prevention must also include advertising bans or high taxes on unhealthy food.

However, it is positive that the extensive criticism from doctors and other self-governing organizations has had an impact in the Federal Ministry of Health. The Federal Joint Committee (G-BA) is now allowed to have a say in the prescription of statins. However, the KBV is critical of the continued provision of advice in pharmacies.

The administrative board of the GKV-Spitzenverband passed a resolution on the law at its meeting today: With the GHG, the coalition is saying goodbye to the guiding principle of prevention, to prevent and avoid health risks, the text states.

In the interests of contributors and patients, drugs and check-ups must continue to have scientific evidence of their effectiveness. In addition, the draft law endangers the prevention structures in Germany that have been built up over the years with contributions from the statutory health insurance (GKV).

The association also invited Martin Scherer, President of the German Society for General Medicine (DEGAM), to give a lecture on the law. He stressed that regular check-ups would reduce the scarce resource of doctors’ time even further, and that check-ups were a waste of time in the practice.

In his view, this would not reach the right people. Healthy people will have their health confirmed. We will not reach the others in this way, Scherer continued. Therefore, the whole law bears the hallmark ‘the main thing is to do something’.

Contrary to initial plans, the G-BA will now be entrusted with the design of the guidelines again. However, in his view, the G-BA will be put in a straitjacket and forced to make decisions that are not evidence-based. The professional association is therefore considering filing a constitutional complaint with the Federal Constitutional Court, announced Scherer.

The G-BA itself described the new draft as a small ray of hope, as the G-BA is now to be more closely involved. The impartial chairman Josef Hecken explained that there had never been any doubt about the goal of identifying and combating risk factors for cardiovascular diseases as early as possible. The danger that health care will move more towards state medicine has been significantly reduced by the new draft.

It is right and sensible that the federal government has taken up the serious concerns about the original regulations raised by the three impartial members of the G-BA and many other organizations during the opinion-giving process,” Hecken continued. Implementing decisions in structured procedures is the core competence of the G-BA, emphasized Hecken.

However, Hecken also criticized the fact that health insurance companies should now reallocate their budgets for prevention in other areas in favor of the planned early detection measures. However, in many cases, a more health-conscious lifestyle and lifestyle changes can be much more effective than lifelong medication, especially when it comes to preventing cardiovascular diseases.

Criticism from health insurance companies

This is precisely where the clear criticism from the ranks of the health insurance companies comes in. The AOK Federal Association sees the traffic light system as completely on the wrong track. The law must be scrapped completely, demanded Carola Reimann, chairwoman of the association.

If these plans are actually implemented, the existing range of prevention and health courses offered by statutory health insurance companies for adults, children and young people will be at acute risk. In doing so, the GHG is counteracting its own objective of improving heart health and promoting exercise and a healthy diet, Reimann continued.

The Association of Statutory Health Insurance Funds (vdek) also considers the law to be superfluous. “It continues with the undifferentiated expansion of early detection tests instead of making a targeted selection of those who could benefit,” said association chairwoman Ulrike Elsner. The misuse of preventive funds must be stopped.

The Association of Guild Health Insurance Funds criticized the fact that the widespread criticism of the plan did not cause the BMG to rethink its position. It is indeed good and right to involve the Federal Joint Committee more in decisions about the use of medication (statins). However, the focus remains on medication to help people quit smoking and on comprehensive screenings at the expense of the GKV’s prevention budget, according to the association. It now called on parliamentarians to fight for truly effective prevention.

The Association of Private Health Insurers (PKV) is also calling for a holistic prevention strategy. With the Healthy Heart Act, the federal government is taking the wrong path. Health promotion and prevention must not be reduced to preventive medicine, complained PKV managing director Florian Reuther.

The proposals are also being received differently in health policy, as a survey by the German Medical Journal The opposition’s health policy spokesman, Tino Sorge (CDU), called for a real campaign to be launched for more sport and healthy eating and for established prevention structures to be expanded.

The Hessian Minister of Health Diana Stolz (CDU) called on the Federal Ministry of Health not to finance the law at the expense of traditional prevention.

The BMG’s draft law itself states that 70 percent of cardiovascular diseases are caused by unhealthy diet, lack of exercise, smoking and alcohol consumption. We therefore urgently call on the federal government to work on this issue, explained the Hessian Health Minister. She called for transparent communication with the states and for them to be included in this project. However, the law does not require approval in the Bundesrat.

Johannes Wagner, representing the Greens in the Bundestag’s Health Committee, announced that the draft law would now be examined in detail in the parliamentary process. “It is particularly important to me that we pursue evidence-based policies in this and every other law that we pass,” said Wagner.

Health insurance funds, which have so far been used to strengthen people’s health literacy and make their living conditions healthier, must continue to be available for this purpose in the future. Anything else would lead prevention in Germany down the wrong path in the long term, Wagner announced.

Nezahat Baradari, SPD member of the Bundestag and the parliamentary group’s reporter for prevention, also said she was open to changes to the law. She had heard the criticism of the law. It sounds trite, but no law leaves the Bundestag in the same condition as it came in.

All comments and studies submitted will be incorporated into the law in the coming weeks. I am sure that in the end a law will be passed that will substantially improve the prevention and treatment of cardiovascular diseases in Germany. © bee/aerzteblatt.de