The first of two special reports prepared by the voluntary Scientific Advisory Board of the Federal Insurance Office (BVA) as the basis for a possible further development of the morbidity-oriented risk structure adjustment (M-RSA) was presented at a press conference at the BVA in Bonn.

>> The first special report with its more than 700 pages, including appendices and literature, will now be finalized in the next three weeks. On the occasion of the presentation of the results, the President of the BVA, Frank Plate, thanked the members of the Scientific Advisory Board and stated: “I am grateful that the Scientific Advisory Board, as an expert and independent body, is dealing so intensively with the evaluation of the RSA and the consequences of possible changes in the RSA. Based on the results of the special report, it is now important to further develop the RSA, which was designed as a learning system, carefully and sensibly. However, it must be taken into account that most adjustments to the distribution mechanism can only be made on the basis of legal changes." But the BVA employees and the scientists working on the advisory board are already working on the second report, which will be available by April 30, 2018 which has to examine the regional distributional effects of risk structure equalization.
Only when this report is available will an overall picture emerge of what a possible further development of the M-RSA could look like. In the opinion of Prof. Dr. Jürgen Wasem, the chairman of the BVA advisory board, will certainly be able to influence some of the recommendations included in the first report - such as a changed consideration of the EMG characteristic (inability to work groups). But not the core statements of the report, which have high potential for improvement for the already “high-performance” (Wasem) M-RSA.
On the one hand, this is the basic recommendation that the previous limitation of 80 selected diseases (diseases) should be switched to a full model, because then there is clear potential for improving the accuracy on all three levels that are important in M-RSA (individuals, insured groups, health insurance companies). ) would be possible. A full model would also make sense because the use of pharmaceutical cost groups (similar to the Dutch RSA) would then also make sense. Furthermore, outpatient diagnoses should be retained because their elimination would not only lead to a significant deterioration in the statistical quality measures of the regression model, but would also increase undesirable incentives for risk selection (overcoverage of healthy people, undercoverage of sick people). The Council also suggests uniform supervisory action at the federal and state levels, and the M-RSA should no longer favor or disadvantage any form of treatment in the future: For this reason, the Council proposes the deletion of the DMP flat rate, as this is an unsystematic promotion of a special format .
While the AOK Federal Association sees the special report on Morbi-RSA as a “good basis for further development”. The reason for the positive opinion is the description of a reform path, how the Morbi-RSA can be made even more targeted and incentives to disadvantage certain groups of insured persons can be further reduced. “Future political decision-makers should now consistently pursue this path,” emphasizes the chairman of the AOK federal association, Martin Litsch.
Criticism, however, comes from Peter Kaetsch, the CEO of BIG Direktgesundheit and spokesman for the RSA Alliance. From his point of view, the purely scientific consideration of the RSA is important, but with a view to the upcoming reform it “necessarily takes the regulatory dimension into account”. Different coverage rates would distort competition, susceptibility to manipulation would remain the Morbi-RSA's Achilles heel, and regional differences in care expenditure would also have to be taken into account. Kaetsch's conclusion: "The report presented, which can only be evaluated from a scientific but also a practical perspective once it has been fully presented, offers initial approaches as to how politics could shape a reform of the Morbi-RSA."
A general criticism comes from the Association of Substitute Funds, for which the special report does not contain any solutions as to how the financial disadvantage of the substitute funds and their insured persons in the Morbi-RSA could be eliminated in the short term. “Instead, a full disease model is proposed that further benefits already covered funds and types of funds,” emphasizes Ulrike Elsner, chairwoman of the vdek. <<