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"Our health care system is a repair"


It is the most powerful woman in health care: Birgit Fischer deduces immediately the largest German health insurance Barmer GEK. In a SPIEGEL ONLINE interview, she talks about women in leadership positions, the disadvantages of Gesundheitsprämie – and the biggest problems in patient care.

SPIEGEL ONLINE: Mrs. Fischer, you are as new head of the newly merged Barmer GEK not only chairman of the members than health insurance, but lead with 22 billion euros in sales also one of the largest companies in the Republic. Are you secretly Dax’s first female-head?

Fischer: My job is similar to a CEO – especially as the Barmer GEK has a significantly larger budget than many a DAX-listed companies achieved sales. In addition, mean about 8.5 million insured persons and approximately 19,500 employees in accordance with a business major responsibility. It’s good that finally once a woman accepts it.

SPIEGEL ONLINE: What do women any better than men?

Fischer: It is in the filling of senior positions is not a question of women or men, "but" women and men ". For both complement each other perfectly. Unfortunately, the German health system is still dominated by men forever. But women also need access to leadership positions are open as well.

SPIEGEL ONLINE: They are now the most powerful woman in the health sector. What purpose is it most important to you?

Fischer: I want to make the Barmer GEK best health insurance for the country.

SPIEGEL ONLINE: Easy is not it. The Barmer been applied not just as a trendsetter. How do you want to do this?

Fischer: We have the unique opportunity to build from Barmer and Gmunder Ersatzkasse (GEK), a new company. Of both worlds, we get the best experience, performance and efficient structures. This leads to both partners in a historic wave of modernization.

SPIEGEL ONLINE: Even at lower administrative costs? With a share of just over five percent of all spending, you are only an average of all funds.

Fischer: Oh God, this miserable discussion about the supposedly high administrative costs. You need us only once compared with the private competition – giving it three times as much. But we will of course set up as lean as possible.

SPIEGEL ONLINE: Nevertheless, the Barmer GEK will probably soon – as have most of the funds – to raise additional contributions from the insured. The lack of health insurance in 2010 four billion euros.

Fischer: We are glad that we started with no additional contribution to the new year and hope that we get a long with our reserves.

SPIEGEL ONLINE: So the additional contribution coming in the second half?

Fischer: We are well positioned financially excluded – but I can not.

SPIEGEL ONLINE: They were formerly health minister in NRW. If politicians do not rule out something called the "Yes".

Fischer: The system is designed so that there will be additional contributions. When depends, among other things, the development of unemployment. In addition, Health Minister Philippe Rösler has promised the doctors higher fees. If we are unlucky, we have to conclude such contracts as lush doctor in Baden-Wuerttemberg. But that would burden the Barmer GEK with half a billion euros.

Listen Online: What additional contribution you start?

Fischer: Everything under eight euros per month makes no sense. Up to this amount insurers have to make any income test for the insured. Of the eight euro before us, only five remain.


Fischer: The additional contribution leads to an absolute administrative madness. Would cost us only the bureaucracy, including dunning two to three per month.

SPIEGEL ONLINE: The additional contribution will be the prelude to the planned by the black-yellow coalition Gesundheitsprämie. Keep the good idea?

Fischer: Definitely not. We have calculated for the statutory health insurance, that a monthly lump sum amount would be needed by around 145 euros. But that would mean that almost two thirds of the Barmer GEK insured would have to rely on a tax subsidy. Million people would be so petitioners – and the whole thing would cost the state even 20 billion euros more.

SPIEGEL ONLINE: Nevertheless, most experts recommend the proposed freezing of the employer. Can you make friends with them?

Fischer: No, because the debate is a red herring. Compared to the annual wage plus health insurance contribution in the fall but on the employer’s costs negligible.

SPIEGEL ONLINE: This will see the company differently.

Fischer: Maybe, but my biggest concern is that adopting the Employer from the responsibility for the health of their employees. In the opposite would be necessary. Especially the increasing demands on the flexibility and mobility of workers lead to more and more sick leave and related costs. Since it is done with sporadic fitness days in the company not long ago.

SPIEGEL ONLINE: What do you expect given your reservations at all by the Reform of the Government, which aims to build up until the summer, a proposal for the financing of health care?

Fischer: I do not think that it will happen, given the resistance in the coalition to a head premium – which would anyway only a Verschlimmbesserung. I hope that the experts have to worry about the real problems of our health care system. And are clearly not alone in the revenue, but also on the expenditure side. Here are the savings and improvement are obvious.

SPIEGEL ONLINE: Where exactly?

Fischer: As far as the medical know-how, our system is one of the best in the world. What we do not succeed, is the closer integration of existing knowledge. There must be a much better coordination between general practitioners, specialists and hospitals.

SPIEGEL ONLINE: This is required for ages, but has so far changed very little.

Fischer: I’m not as pessimistic, but the fact is that all the lobby groups act to build their fences higher and defend with all his might: The representatives of doctors, pharmaceutical manufacturers and pharmacies with the policy solutions, but can live with all stakeholders. Who in the talks but almost never is at the center, is the patient.

SPIEGEL ONLINE: How could the situation change?

Fischer: While we do not keep more absurd debates, in which a permanent fear of a supply emergency is stoked. Including physicians, we must finally determine the true needs, then develop concepts for the supply and quality standards that guide the good work and an appropriate remuneration. It must be transparent to the patient who provides what services for what price and at what quality.

SPIEGEL ONLINE: Suppose you were one days in Berlin and the health minister would have to take on anyone regardless. What would you do to achieve this objective?

Fischer: I would give health insurance companies more leeway and contractual freedoms. What we need is a trendsetter in the interest of the insured to raise the economic efficiency reserves and enforce the necessary improvements in care – for example in negotiations with doctors.

SPIEGEL ONLINE: Is not it too easy to always complain only to the lobby groups? At the same time, the Germans are world champions for doctor visits.

Fischer: Of course, everyone has a personal responsibility, which is why I am the subject of prevention is so important. Currently, our health care is a particular repair shop. Everyone would pay more attention to his health, some diseases could be avoided.

SPIEGEL ONLINE: A nice call – and not the first of his way when will it be cool to bite into an apple instead of eating fast food?

Fischer: I’m optimistic that will prevent the mainstream. 20 years ago were the people who have separated the garbage, even ridiculed. Today, everyone does it.

SPIEGEL ONLINE: What are you doing personally to your health?

Fischer: I’m no better off than most, I Hangeler me from a good resolution to the next. But whenever it does, I go jogging. This works to happiness always and everywhere.