EKK-MEDIFACT as an Independent Authority for Optimizing Medical Treatments
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15.6.2026 This is a key element of the EKK-MEDIFACT concept. The core idea is not that EKK-MEDIFACT replaces the physician. Rather, as a neutral knowledge and coordination authority, EKK-MEDIFACT has a complete overview of every patient’s medical history and medication record. It can therefore help, within seconds, to prevent wrong decisions, duplication of services, and unnecessary procedures. Only EKK-MEDIFACT reviews all reimbursements and records them in the EKK patient file. It also knows whether a treatment was successful or whether follow-up treatments became necessary.
According to Article 117 paragraph 9b, EKK-MEDIFACT evaluates planned treatments with regard to medical necessity and cost-effectiveness, grants or refuses reimbursement approval, and determines the most appropriate healthcare providers.
This task requires EKK-MEDIFACT to possess information that is often only partially available to an individual physician, hospital, or therapist. This is precisely where the system’s unique strength lies.
While the treating physician primarily relies on the current examination and the records available to him or her, MEDIFACT has access to the complete electronic patient file. This file contains a person’s entire medical history, including previous diagnoses, treatments, operations, medications, laboratory results, medical imaging examinations, and their outcomes.
This creates a level of knowledge that exceeds the capabilities of individual healthcare providers. MEDIFACT can identify connections that often remain hidden in everyday practice. It can determine which therapies have already been attempted, which were successful or unsuccessful, and which alternative treatment options have produced good results in comparable cases. At the same time, EKK-MEDIFACT can also learn about new and practical therapeutic approaches through the treating physician.
The role of EKK-MEDIFACT is not to make medical decisions independently. Rather, the system is intended to ensure that all available information is included in the assessment process. This enables treating physicians to become aware of additional findings, scientific recommendations, or the experiences of other specialists.
In many cases, this can improve treatment quality. Unnecessary duplicate examinations can often be avoided. EKK-MEDIFACT may also identify particularly experienced specialists or specialized centers that are better suited to a specific medical issue than the institution originally selected.
Of particular importance is the ability to critically review surgical procedures. Not every operation is necessarily required. Conservative treatment methods often exist that provide equal or even better effectiveness while involving lower risks and lower costs. Through its comprehensive evaluation of all available information, EKK-MEDIFACT can identify such alternatives and thereby help prevent unnecessary operations.
Reimbursement approval is therefore not granted or denied solely on the basis of an individual request. It is based on a comprehensive assessment of all available medical data, scientific knowledge, and economic considerations. The objective is always to select the treatment that provides the greatest benefit to the patient at reasonable cost.
EKK-MEDIFACT therefore does not serve to restrict medical freedom but rather to complement it through a comprehensive, neutral, and patient-oriented assessment. Patients benefit from higher treatment quality, healthcare providers benefit from better decision-making foundations, and the community benefits from a more effective use of available resources.
In this way, a healthcare system emerges in which the focus is not on the number of treatments performed but on their actual benefit to the patient.
The above constitutes the fundamental justification for why EKK-MEDIFACT grants or refuses reimbursement approvals.
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