Healthcare Savvy

You may want to compare what someone in Germany pays for the same services. I became interested after watching T.R Reid’s “Sick Around the World” especially where he had claimed that in Germany and Japan there is a single Price for all fee for services no matter where you went for care.

The Translated Wikipedia Explaining Fee for Doctors Statute in Germany

In Germany The GOA is negotiated by the Doctors, Dentists and Insurance companies etc. Since I only wanted to talk about the fee schedules I will leave it at that only to say that the results of this negotiation becomes Federal Law Everywhere you go in Germany.

The is Site in German. Translated from Google

How is the Fee Calculated?

A Medical Fee charge is calculated from the rate in Euros 0.0582873 times the Performance Points. The Points are a measure of Medical effort and Ranking.

The First charge next to the Points is the Simple Fee Rate of charge
and 2nd Fee is the Rate of Charge X 1.8

In the Example Below. The Benefit number is 5700 for a Head and Neck MRI. The Provider’s Performance is assigned 4400.

This is multiplied by the rate of charge € 0.0582873. The Maximum Rate is 1.8 times the rate of charge.

Example

5700   This is the Benefit Number Not the ICD Code

Magnetic resonance imaging in the head if necessary including the neck, in two projections,
including at least one projection on T2-weighted images including

POINTS                                Simple Fee                  [ Fee 1.8 x the rate of charge]

Performance Points = 4400

4400 x 0.0582873=256.46 in Euros (4400 x 0.0582873) * 1.8 (1.8 * rate of Charge)  =461.64 in Euros

In this case the charge maybe between 256 and 461 Euros [461 Euros translate to [1.34 Euros to the $ I]  $618.00 US Dollars]

2nd Example

GOA Charge Detail

for 5265 Mammography (300 x 0.0582873 x 1.8)= 31.48 Euros or $ 42.17 Dollars

5265

Mammography a page in a plane

The significance of this Scheme is that it is the Law of the land in Germany. Everyone has to be insured by Federal Statute and with few exceptions the Published Fees cannot be deviated from. The single Fee schedule is the single most important factor in Keeping Medical Costs lower in Germany. Think about Fee schedules in the USA. Each Medical provider has their own Proprietary UCR (Usual Customary and Reasonable -Hardly..) Fee [for Cash paying patients] and a seperate Fee Schedule for Each insurance Plan that the practice or facility is contracted with.

This Data overhead adds dramatically to the administrative cost of the Practice.