Assistive devices for illness and care
By Heidi Heinhold
Questions arose at MEDICA 2008 about which assistive/care devices reach patients, what is their quality and who pays for them.
Legal definitions
• Assistive devices are actual medical services, such as prostheses, bandages, walking frames, suction apparatus, mattresses etc., i.e. all services and items that counteract the physical or mental functional deficits of patients, ensuring ongoing treatment success or the prevention of disability. These devices listed in the assistive devices index and must be prescribed by a doctor. The costs are either fully or partially borne by medical insurers.
• Care devices are tangible means or technical aids that ease care, relieve the medical conditions of those who need care and help to facilitate an independent lifestyle. The costs are borne by nursing care insurers up to a certain limit. Care devices are listed in the care devices index.
How products reach patients
a) A patient visits the doctor, who diagnoses the illness and need for an assistive or care device. He issues a special prescription.
b) The patient contacts his/her medical insurer which names its ‘preferred suppliers’, which have contracted to supply devices with favourable costs for the insurer.
c) From this list, a patient chooses the closest supplier to where s/he lives (in some cases, up to 50 km distance is acceptable, according to insurers). The patient receives an estimate which must then be authorised by the insurer, and it will then be prepared to cover the costs, less the amount the patient legally must pay.
Who covers the costs?
Insurers – Statutory insurance based on the SGB (Social Security Code) V, statutory nursing care insurance (SGB XI), statutory accident insurance (SGB VII); private insurance
Statutory medical insurance and nursing care insurance are statutory insurances for all workers and employees with a certain, top level of earnings, as well as pensioners, recipients of social security and the unemployed. Employers and employees usually share the contributions 50:50, the self-employed pay for both shares. The cost of this insurance for pensioners, social security recipients and the unemployed is covered by the respective statutory pension insurers and authorities.
From a certain level of income upwards it is possible to take out private insurance. This also applies for the self-employed and civil servants. With private insurance, the insured person pays for services up front and, depending on the contract, is either reimbursed the full costs or a partial amount.
The patient – Because insurers only cover costs up to a certain limit, the patient must bear a certain share of costs determined by law. If he wants a certain product from a specific supplier he must also bear any additional costs this may involve. This contribution requirement also applies to care devices.
20.12.2008
