風蕭蕭_Frank
以文會友
German Health Minister Karl Lauterbach
internetpost@bundesregierung.de
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https://www.bundesregierung.de/breg-en/federal-government/ministries/federal-ministry-of-health
July 23, 2023, Minister wants to stop investors buying medical practices
German Health Minister Karl Lauterbach plans to present a law in the first quarter of next year to stop what he called “locust” investors buying up medical practices.
德國衛生部長欲禁止投資者購買醫療機構
在德國，國際投資者正在購買越來越多的醫療診所。批評人士警告，這可能導致昂貴且不必要的治療。
德國衛生部長卡爾·勞特巴赫希望“多一些醫療，少一些利潤”
（德國之聲中文網）德國醫保領域一直以來都運作良好且基本上不受經濟危機的影響。因此，國際投資者多年來在德國不斷購買越來越多的醫療診所作為投資項目，而正是這種趨勢引起了衛生專家和患者的擔憂。
他們的擔憂在於，企業為實現利潤最大化，會促使醫生提供不必要的治療項目。尤其是那些昂貴的附加服務，而這些服務不在保險範圍內，需由個人支付。
一項由非政府組織"金融轉型研究"（Finanzwende Recherche，一間成立於2018年，旨在對金融市場進行改革的機構）五月份發布的研究顯示，私募股權公司在2022年購買了174家德國診所，而2021年為140家，2010年僅有兩家。
超過500家醫院歸投資者所有
根據北德廣播公司（NDR）的調查，此類公司目前在德國擁有數百家診所，在某些地區和城市，個別連鎖機構甚至占據了壟斷地位。NDR調查顯示共計有500家醫院歸投資者所有。然而實際數字可能更高，因為沒有規定有義務公開醫療院所的所有權，而這正是許多衛生專家希望改變的現況。
政府從去年起開始關注這個問題，社民黨籍的衛生部長勞特巴赫（Karl Lauterbach）表示："我將製止投資者純粹出於逐利的欲望進行醫療診所收購。"他宣布將提交一項法案，"以阻止這些蝗蟲飛入診所"。
德國醫院見利忘義? 追逐利潤還是醫療保障？
勞特巴赫的言論得到了霍斯特·赫爾比格（Horst Helbig）的支持。後者是德國眼科學會發言人、裏根斯堡一家眼科診所的負責人。他認為投資者投資診所純粹是為了盈利。
"投資集團的目的完全是盈利，他們沒有其他目的，也不會有其他目的"，赫爾比格說。"當然，醫生經營的診所也需要盈利。但他們的主要目標是提供醫療服務。"
私保病人比公保病人更受歡迎？
一家針對基礎設施和健康問題的獨立研究谘詢機構IGES於2022年發表的研究似乎證實了這一點。該研究得出結論稱，由投資者擁有的診所比私人醫生開設的診所至少多賺取10%的費用。
德國擁有一個由雇員和雇主共同向醫療保險公司繳納保金的雙層醫療係統，醫療保險對所有人都是強製性的。覆蓋約90%人口的法定保險公司不得拒絕向任何人提供醫療支持，另有10%的人口繳納私人健康保險以獲得更多保障。德國醫療衛生體係每年總支出高達數千億歐元。
萊比錫一家醫院的重症監護室
赫爾比格表示，他已經注意到這樣一種趨勢，即由投資者擁有的醫療機構拒絕接受公保患者，而把重點放在那些可以帶來利潤的患者身上。"治療有些患者是可以賺取利潤的，治療有些患者則需要花錢，我們注意到許多無利可圖的患者被轉移到公立醫院"他告訴德國之聲說。
風險高的商業模式
這在眼科診所中尤為明顯，因為不同治療之間存在巨大的價格差異，其中部分治療費用不在保險範圍內。"白內障手術報酬高，而急診手術的報酬就很低"，赫爾比格解釋說。此外，更為複雜的白內障手術會被轉移到公立醫院，可能是因為這些病人的白內障已經到很晚期了。
"金融轉型研究"機構計算得出，投資者可以預期從他們的投資中獲得高達20%的利潤——前提是他們購買足夠多的診所。研究員Aurora Li表示，私募股權公司的商業模式是將多個診所整合在一起，然後進行風險重組（有時借助於貸款），以便日後通過再次出售以獲利。
一些患者擔心成為金融投資者的投資對象
專注於利潤最大化
"重點不在運營利潤上，而是在持續的現金流入上"，Aurora Li在接受德國之聲采訪時說。"如果企業對醫生施加壓力，推銷盈利的治療方案並確保持續的現金流入，那對其他金融投資者而言是有利可圖的。隻有擁有眾多醫療診所，才能創造高現金流。"
她進一步指出，如果患者不確定自己的治療是否是受到盈利驅使，這將是非常令人擔憂的。她說："另一個風險在於，強加給這些醫療機構的商業模式風險很高，有可能導致它們迅速破產。特別是當貸款利率較高從而導致成本增加時。"根據Aurora Li的說法，在這種情況下，投資者可能會選擇關閉診所。
有些手術費用高昂，許多醫療機構需為此做好財務規劃
醫生協會對衛生部長的批評持不同看法
勞特巴赫所宣布的法案尚未出台，但一些醫生協會表達了與衛生部長不同的看法。例如，聯邦醫療中心經營者聯合會（Bundesverband der Betreiber medizinischer Versorgungszentren）指出，沒有政府數據顯示，投資者擁有的診所其醫療質量比其他醫療機構要差。
受雇於醫療服務中心的醫生於5月份發表了一封公開信，憤怒地駁斥了勞特巴赫的質疑，”作為受雇醫生，我們對患者的用心和投入的精力與我們在獨立診所或醫院的同行一樣……不幸的是，我們注意到自己的工作受到了……公開的貶低。"
對於迫於經濟壓力而進行的診所整合，赫爾比格並不完全持反對態度。他表示，隻有相當少數的年輕醫生有能力完成必要的投資。也很少有人願意每周工作60小時——而這是創辦自己的診所所必需的。他說：“當然，我們可以要求減少繁文縟節和官僚主義。但我也知道，期待德國在這方麵有所改變是有點天真的。”
Minister wants to stop investors buying medical practices
Good and largely crisis-proof business has always been possible with health. For this reason, international investors have been buying up more and more medical practices in Germany for years as investment properties. A trend that health professionals and patients are watching with concern.
They fear that the corporations will encourage doctors to offer unnecessary medical treatments in order to maximize profits. In particular, those that include expensive additional services that are not covered by insurance but are billed privately.
A study released in May by non-governmental organization Finanzwende Recherche – an association founded in 2018 to reform financial markets – found that private equity firms bought 174 German medical practices in 2022, 34 more than in the previous year. In 2010 there were only two.
More than 500 clinics owned by investors
According to research by Norddeutscher Rundfunk, such companies now have hundreds of practices throughout Germany, so that individual chains have a monopoly position in certain regions and cities. The NDR identified a total of 500 hospitals owned by investors. The true number is unknown, however, because there is no requirement to publicly disclose ownership — a fact many health experts want to change.
The Federal Government took the issue into account last year. “I’m putting an end to investors buying up medical practices out of absolute greed for profit,” said the Social Democratic Health Minister Karl Lauterbach. He announced that he would introduce a bill “so that these locusts will no longer come into the doctor’s office”.
Profits or medical care?
When he declared war on investors, Lauterbach got the backing of Horst Helbig. For the spokesman of the German Ophthalmological Society, the scientific society for ophthalmology, and head of an eye clinic in Regensburg, investor clinics are purely geared towards profit.
“The purpose of an investment group is 100 percent to make a profit. They don’t want anything else and at the end of the day they are not allowed to do anything else,” says Helbig. “Of course, even a single clinic owned by the medical profession has to make money, but its main purpose is medical care.”
A study by the independent research and consulting institute for infrastructure and health issues from 2022 seems to confirm this. She found that investor-owned clinics earned at least 10 percent more fees than those owned by individual doctors.
Cementing the two-tier medicine?
In Germany there is a two-tier healthcare system that is financed by contributions from employees and employers to the health insurance companies. Health insurance is compulsory for the entire population. The statutory insurers, which cover around 90 percent of the population, are not allowed to refuse their support to anyone. The other ten percent often enjoy more protection with private health insurance. Overall, the German healthcare system costs several hundred billion euros every year.
Some patients fear that they could become an investment object for financial investorsImage: Benjamin Nolte/dpa/picture alliance
Helbig says he’s noticed the trend of new investor-owned medical practices turning away publicly insured patients and focusing on those that bring profit. “Some patients are lucrative, others cost money. We have found that many patients who cannot be treated profitably are transferred to public hospitals,” the health expert told DW.
Risky business model
This is particularly noticeable in eye clinics, where there are large price differences between the treatments, some of which are not covered by insurance. “Cataract surgery is well paid, whereas emergency procedures of any kind are poorly paid,” explains Helbig. In addition, more complex cataract operations would be transferred to public hospitals, possibly because the cataract is already well advanced.
Pediatricians in crisis mode
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Finanzwende research has calculated that investors can expect a profit of up to twenty percent from their investments – but only if they buy enough practices. The business model of private equity funds consists of bundling several practices and restructuring them – sometimes with the help of loans – in order to later sell them for a profit, says finance transition researcher Aurora Li.
Focus on profit maximization
“The focus is not on operating profit, but on the steady inflow of capital,” Li told DW. “When companies put pressure on doctors to sell profitable treatments and provide a steady cash flow, that can become profitable for other financial investors. And you can only generate high cash flow if you own a lot of doctor’s offices.”
Some surgeries are expensive, so many medical facilities need to plan well financiallyImage: Channel Partners/Zoonar/picture alliance
It is very worrying when patients are unsure whether their treatment will not be influenced by profit expectations. “Another danger is that the business model imposed on these medical practices is very risky and they can quickly go bankrupt. Especially when higher interest rates on the loans translate into higher costs.” Then, according to Li, investors could have the practice shut down.
Medical associations put Lauterbach’s criticism into perspective
The draft law announced by Karl Lauterbach is still pending, but some medical associations assess the issue differently than the Minister of Health. The Association of Health Care Center Operators, for example, pointed to government data that said there was no statistical evidence that mutual fund-owned clinics provided poorer medical treatment.
Federal Minister of Health Karl Lauterbach wants to reduce the influence of investors on the healthcare systemImage: Tobias Schwarz/AFP/Getty Images
Doctors employed there also published a letter in May angrily dismissing Lauterbach’s claim that her independence could be questioned. “As employed doctors, we practice our profession with the same passion and the same commitment to the patient as our colleagues from private practices or in hospitals.”
Horst Helbig is also not fundamentally opposed to the bundling of practices because of the economic burden. For example, only a few young doctors are able to make the necessary investments. And few are willing to put in the 60-hour work week that is required to start their own practice. “Of course you can demand that the bureaucracy, which in practice really overwhelms you, be dismantled. But I also know that it’s a bit naïve to expect this to actually happen in Germany.”
The article originally appeared in English and has been adapted.
