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PPrivate patients are used to being treated a little better in the health system than patients with compulsory health insurance. For this they usually pay higher contributions. If it works the other way around, it makes you sit up and pay attention. Like recently in a pharmacy in the Rhine-Main area. There, a private patient wanted to trade in a prescription for a flu shot and was dismissed with disdain. On the basis that the vaccine doses in stock are reserved for those who have mandatory medical insurance.
Sebastian Balzter
Economics editor at the Frankfurter Allgemeine Sonntagszeitung.
That may be an isolated case. Large private health insurance companies such as Allianz, Debeka and DKV have yet to report any widespread problems. However, the topic is of special interest this year. It could well be that the flu vaccine is generally in short supply, and so private patients could be at a disadvantage from time to time.
That’s because of how the flu vaccine is distributed, loaded, and stored. This is very different from other medications. Vaccine manufacturers, pharmaceutical groups such as Glaxo-Smith-Kline (GSK) and Sanofi, do not deliver the vast majority of their production to pharmacies in single-dose pre-filled syringes, but in packs of ten. In most cases, these bulk packages are shipped to physicians’ offices as office hours and used there on a patient-by-patient basis. This is how legal health insurance has been arranged with legal health insurance associations. Consultation hours are billed at a flat rate. In principle, it is therefore not allowed to supply this quota of vaccine to private patients.
A new vaccine every year
Alexander von Waldenfels, owner of Kur-Apotheke in Schliersee and a member of the board of the Bavarian State Chamber of Pharmacists, explains the three ways you can still get a flu shot as follows: either the treating doctor has a small additional supply in addition to office hours at your own business risk One-time doses created to vaccinate private patients and resolve with their insurance companies. Or the pharmacy, where the particular patient presents a single dose with his prescription, has such a supply.
The case described at the beginning shows that this cannot always be trusted. Pharmacists or doctors are not required to do so. Then the third option comes into play, the so-called “individualization” of a ten-pack dose at the pharmacy. This requires some organizational effort and raises the question of how the pharmacist can dispose of the remaining nine cans, each of which costs around 20 euros. Returning the leftovers or saving them for the next year is not an option.
Because the composition of the vaccine, determined by the World Health Organization (WHO), changes from year to year depending on the current infection rate. Therefore, “pointing” is not a popular exercise. Also, a leaflet is missing and, in some cases, an additional cannula is necessary because it is not always included. “This is why this is only allowed in exceptional cases,” explains Alexander von Waldenfels. For example, when the treating doctor notes in the private prescription that it is an emergency.
If necessary, the insurance pays for ten doses of vaccine per patient.
In theory, private health insurance companies could enter into their own contracts with vaccine manufacturers and secure premiums for their clients. In practice, however, they do not do so because they cannot force their policyholders to accept the preparation of a certain manufacturer. Its bargaining power is also less than that of mandatory health insurance, which covers around 90 percent of the population. But the private sector doesn’t want to be raggedy either. When in doubt, a spokesman for the Private Health Insurance Association assures that the pharmacist, who is concerned about reimbursement for the remaining nine doses when dispensing the vaccine for a particular patient, would also pay for the entire package of ten.
