interview
A new law should result in fewer cardiac deaths. But the health insurance companies are resisting: The Heart Act leads to billions in additional costs and does not help patients.
In Germany, the vast majority of people die from heart attacks or strokes. With the right early detection, many lives could be saved. Is Karl Lauterbach’s Healthy Heart Law the right way?
As health insurance companies, we support the goal of reducing the number of heart attacks and strokes. But the bill goes in completely the wrong direction and endangers the health insurance companies’ ongoing prevention and health courses. Instead of strengthening prevention, the law prioritizes drug therapies. We strictly reject an approach based on the motto “pill instead of prevention”. This does not really improve patient care in the long term.
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But what speaks against offering people regular check-ups and making sure that children and young people’s cholesterol levels are not too high?
The plans do not address the root of the problem. Exercise, healthy eating and relaxation are left out. Preventive medical examinations and cholesterol checks are important, but they are not enough. We need more prevention, not less. Municipalities can make offers here that help people move more and eat better. In kindergartens and schools, education is important, but so are better school meals and more physical education. And of course, curbing tobacco consumption and reducing obesity also play a major role. This is where a cardiovascular strategy should come into play.
Are there countries that are doing it better?
Yes, some. Just one example: Finland has been successfully reducing cardiovascular diseases since the 1970s with the North Karelia Project. The region had one of the highest death rates from heart disease in the world. The residents of this region have now gained ten more healthy years of life, according to the results of a study supported by the World Health Organization. Above all, the project shows that it is not enough to educate people about healthier behavior. The living environment must become healthier. The local butcher used less fat and salt, the schools cooked more nutritious meals, and tobacco advertising was banned.
The Healthy Heart Act is also about prevention, smoking cessation, educational discussions and more pharmacy services. You should actually be cheering.
We also supported these points. But that doesn’t change the core of the law, which directs preventive agents into drug therapy. We strictly reject that.
A healthy lifestyle certainly makes sense, but in many cases elevated cholesterol levels are not the result of an unhealthy lifestyle. In the genetically determined form of hypercholesterolemia, diet and exercise play an absolutely subordinate role.
These cases exist. But unrecognized familial hypercholesterolemia is rarely the cause of cardiovascular disease. Adults with lipid metabolism disorders usually have decades of an unhealthy lifestyle behind them. Drug therapy often only serves to stop existing diseases such as high blood pressure, arteriosclerosis and diabetes from worsening. It is therefore more important to promote a healthy lifestyle at an early stage rather than prescribing medication across the board, which can always have side effects. This way we could all live longer.
Many studies show that statins are safe, effective and can save many lives when patients take them. Why the reservations from the health insurance companies’ perspective?
Criticism doesn’t just come from the health insurance companies. Other institutions also criticize the fact that a certain supply of medication should be prescribed without clear evidence, which endangers established methods of prevention. Experts such as Josef Hecken from the Federal Joint Committee and the General Practitioners Association share these concerns. When prescribing statins to children, there is a lack of clear studies on possible long-term consequences.
But you would also be able to save considerable costs. The justification for the law states that the costs for more prevention today are significantly lower than the costs for all the many heart patients later.
The savings potential is completely out of thin air, and Mr. Lauterbach does not provide any evidence for this. On the contrary: just expanding the “Disease Management Programs” (DMP) for high-risk patients could lead to additional costs of 3.8 billion euros per year after five years, according to AOK calculations. And we not only see additional burdens on statutory health insurance, which can lead to higher contributions, but also a significant additional burden on doctors’ practices. If the plans are consistently implemented, family doctors would have to care for 34 million additional patients in disease management programs. For each of the around 44,000 general practitioners currently involved in the DMP, this would mean around 32 additional working days per year.
Source: Stern
