风萧萧_Frank
以文会友
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.
德国卫生部长欲禁止投资者购买医疗机构
在德国，国际投资者正在购买越来越多的医疗诊所。批评人士警告，这可能导致昂贵且不必要的治疗。
德国卫生部长卡尔·劳特巴赫希望“多一些医疗，少一些利润”
（德国之声中文网）德国医保领域一直以来都运作良好且基本上不受经济危机的影响。因此，国际投资者多年来在德国不断购买越来越多的医疗诊所作为投资项目，而正是这种趋势引起了卫生专家和患者的担忧。
他们的担忧在于，企业为实现利润最大化，会促使医生提供不必要的治疗项目。尤其是那些昂贵的附加服务，而这些服务不在保险范围内，需由个人支付。
一项由非政府组织"金融转型研究"（Finanzwende Recherche，一间成立于2018年，旨在对金融市场进行改革的机构）五月份发布的研究显示，私募股权公司在2022年购买了174家德国诊所，而2021年为140家，2010年仅有两家。
超过500家医院归投资者所有
根据北德广播公司（NDR）的调查，此类公司目前在德国拥有数百家诊所，在某些地区和城市，个别连锁机构甚至占据了垄断地位。NDR调查显示共计有500家医院归投资者所有。然而实际数字可能更高，因为没有规定有义务公开医疗院所的所有权，而这正是许多卫生专家希望改变的现况。
政府从去年起开始关注这个问题，社民党籍的卫生部长劳特巴赫（Karl Lauterbach）表示："我将制止投资者纯粹出于逐利的欲望进行医疗诊所收购。"他宣布将提交一项法案，"以阻止这些蝗虫飞入诊所"。
德国医院见利忘义? 追逐利润还是医疗保障？
劳特巴赫的言论得到了霍斯特·赫尔比格（Horst Helbig）的支持。后者是德国眼科学会发言人、里根斯堡一家眼科诊所的负责人。他认为投资者投资诊所纯粹是为了盈利。
"投资集团的目的完全是盈利，他们没有其他目的，也不会有其他目的"，赫尔比格说。"当然，医生经营的诊所也需要盈利。但他们的主要目标是提供医疗服务。"
私保病人比公保病人更受欢迎？
一家针对基础设施和健康问题的独立研究咨询机构IGES于2022年发表的研究似乎证实了这一点。该研究得出结论称，由投资者拥有的诊所比私人医生开设的诊所至少多赚取10%的费用。
德国拥有一个由雇员和雇主共同向医疗保险公司缴纳保金的双层医疗系统，医疗保险对所有人都是强制性的。覆盖约90%人口的法定保险公司不得拒绝向任何人提供医疗支持，另有10%的人口缴纳私人健康保险以获得更多保障。德国医疗卫生体系每年总支出高达数千亿欧元。
莱比锡一家医院的重症监护室
赫尔比格表示，他已经注意到这样一种趋势，即由投资者拥有的医疗机构拒绝接受公保患者，而把重点放在那些可以带来利润的患者身上。"治疗有些患者是可以赚取利润的，治疗有些患者则需要花钱，我们注意到许多无利可图的患者被转移到公立医院"他告诉德国之声说。
风险高的商业模式
这在眼科诊所中尤为明显，因为不同治疗之间存在巨大的价格差异，其中部分治疗费用不在保险范围内。"白内障手术报酬高，而急诊手术的报酬就很低"，赫尔比格解释说。此外，更为复杂的白内障手术会被转移到公立医院，可能是因为这些病人的白内障已经到很晚期了。
"金融转型研究"机构计算得出，投资者可以预期从他们的投资中获得高达20%的利润——前提是他们购买足够多的诊所。研究员Aurora Li表示，私募股权公司的商业模式是将多个诊所整合在一起，然后进行风险重组（有时借助于贷款），以便日后通过再次出售以获利。
一些患者担心成为金融投资者的投资对象
专注于利润最大化
"重点不在运营利润上，而是在持续的现金流入上"，Aurora Li在接受德国之声采访时说。"如果企业对医生施加压力，推销盈利的治疗方案并确保持续的现金流入，那对其他金融投资者而言是有利可图的。只有拥有众多医疗诊所，才能创造高现金流。"
她进一步指出，如果患者不确定自己的治疗是否是受到盈利驱使，这将是非常令人担忧的。她说："另一个风险在于，强加给这些医疗机构的商业模式风险很高，有可能导致它们迅速破产。特别是当贷款利率较高从而导致成本增加时。"根据Aurora Li的说法，在这种情况下，投资者可能会选择关闭诊所。
有些手术费用高昂，许多医疗机构需为此做好财务规划
医生协会对卫生部长的批评持不同看法
劳特巴赫所宣布的法案尚未出台，但一些医生协会表达了与卫生部长不同的看法。例如，联邦医疗中心经营者联合会（Bundesverband der Betreiber medizinischer Versorgungszentren）指出，没有政府数据显示，投资者拥有的诊所其医疗质量比其他医疗机构要差。
受雇于医疗服务中心的医生于5月份发表了一封公开信，愤怒地驳斥了劳特巴赫的质疑，”作为受雇医生，我们对患者的用心和投入的精力与我们在独立诊所或医院的同行一样……不幸的是，我们注意到自己的工作受到了……公开的贬低。"
对于迫于经济压力而进行的诊所整合，赫尔比格并不完全持反对态度。他表示，只有相当少数的年轻医生有能力完成必要的投资。也很少有人愿意每周工作60小时——而这是创办自己的诊所所必需的。他说：“当然，我们可以要求减少繁文缛节和官僚主义。但我也知道，期待德国在这方面有所改变是有点天真的。”
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.
