(Mess; 01-06; p.3)

A new policy – and an analysis

Early in 2006, the German government started working on reforming the health system and has presented the so-called "cornerstones" ("Eckpunkte" in German) that state policy-guidelines on this in July. The following gives a summary and analytical notes.

On expenditure:

The GKV is obliged to pay for equal doctor's services equally on a Euro-basis, but insurers may stipulate their own contracts with doctors or their representative bodies. Private insures do not have to do so, they may spend money for bonuses freely; they also may conclude contracts with employees whose income has been above the limit (the 3,500 Euro per month) for three continuos years.

The GKV shall engage in drugs purchasing, so using their buyers' powers for better conditions; drugs prices, stipulated by the state, will become mere upper limits in the future. Pharmacists shall engage in that as well: If they don’t achieve savings of 500 million Euro in 2007, they – and not the pharmaceutical industry – have to pay this amount to the GKV.

The GKV and hospitals have to spend 0.5 % of their respective budgets on integrated services; hospital treatment, temporary care or rehabilitation and eventual therapy with the doctor's shall be better co-ordinated by this. Apart from that, the hospitals budget will be reduced by one percent in favour of the GKV, and the GKV will only pay for certified rehabilitation.

Customers within the PKV will get the right to change between companies. Non-insured, former customers will have to become insured again on "payable" premium conditions – a less unprecise term like e.g. "on GKV-conditions" has not been chosen by the law makers. The PKV has to participate in "essential prevention" measures – a less unprecise term has been avoided as well.

Doctors shall be paid for their services on a 'Länder'-wide equal basis (Germany is subdivided into sixteen different 'Länder' like the states of the US.). They will get full payments up to their fixed costs, beyond their break-even, only marginal payments will be given. – The law makers do not give any advice on how to implement this guide-line.
Ordering special high-price medication and in the long run also ordering high-price diagnostics and therapies shall be reserved to especially qualified doctors. A free choice of doctors, including those in hospitals and clinical centres, shall be possible nonetheless, a development to a structure of respective specialised doctor's offices shall be avoided. – The law makers did not elaborate on any conflict of goals in respect to that.

The GKV has to pay for newly registered drugs at least until a costs-benefits-analysis has been done on them; if no unanimous judgement on a new drug by the board in charge, the "Gemeinsame Bundesausschuss", can be reached, costs have to be paid on. "On request" medical extra benefits of a new drug will be analysed; once proved, prices for it have to be negotiated freely between GKV and the pharmaceutical industry, fixed prices or upper limits become obsolete.
(read on here)