>> “Data transparency” is the keyword that will give healthcare research the opportunity to access a comprehensive pool of routine data from statutory health insurance from next year. The title “data transparency” has been found in SGB V since the GKV Modernization Act of 2004. However, its implementation was delegated to the self-administration, which ultimately led to a standstill in this area for years due to unresolved financing and implementation issues.

It was only with the adoption of the Supply Structure Act at the end of 2011 that the issue gained new impetus, with the BMG taking the reins of action into its own hands. Accordingly, the routine data used to calculate the Morbi-RSA will also be available at DIMDI in the future for health services research purposes. In addition to demographic characteristics, this data set includes billing data from outpatient and inpatient care as well as medication prescriptions for the approximately 70 million people with statutory health insurance in Germany. The information will not only be available as a cross-section, but will also be prepared as a longitudinal section over the years. This cross-sector data enables, among other things, analyzes of healthcare provision, drug epidemiology and (utilization-based) disease incidence and prevalence.

But this new data transparency regulation is also not without its flaws: a number of relevant information is missing, which is part of the GKV routine data, but is not part of the data set due to its irrelevance for the calculation of the Morbi-RSA. This includes, for example, the relationship between service providers, which is crucial for studies of the quality of care provided by individual service providers.

A very significant limitation to possible insights from this data is the lack of regional characteristics, i.e. the possibility of assigning each insured person to their place of residence (e.g. based on the district code). While this feature is currently recorded in the Morbi-RSA data, it will be eliminated in the future - and therefore in parallel with the implementation of the data transparency regulation. The reason for this is the expiring convergence regulation, which was intended to prevent the Morbi-RSA from having an excessive financial redistribution effect between the federal states (Section 272 SGB V). This previously formed the legal basis for recording the regional feature.

What are the consequences of the elimination of the regional feature? Three aspects particularly stand out here:

Firstly, this prevents regional structural indicators from being taken into account. However, we know that provider structures, such as physician and hospital bed density, have a significant impact on the quantity (and possibly quality?) of care. On the other hand, it also makes sense to include demand-side determinants: Since the available routine data does not allow any conclusions to be drawn about the socio-economic status of the individual insured person, the regional code could at least take into account the social situation of the district based on unemployment or income statistics.

Secondly, regionally limited analyzes with the data become impossible. However, in order to plan care structures in line with needs and close to where people live, data is first required that describes the small-scale status quo of health and care and thus allows an approximation of the care needs.

A third aspect is regional comparative analyses. This branch of research is still in its infancy in Germany - in contrast to some of our neighboring countries. However, if we take seriously the goal of “needs-based and consistent” care (Section 70 Para. 1 SGB V), which is anchored in social law, there should not be systematically worse care in individual regions than in others. Research results that indicate significant regional differences, for example in cancer mortality (Sundmacher 2011) or the quality of pharmacotherapy for older people (Riens and Mangiapane 2012), therefore urgently require further research into the causes.

Against this background, a petition was recently created that calls on the German Bundestag to retain the regional characteristic in the data. Its co-signers include numerous scientists from health services research, health sciences and health economics, including four members of the Expert Council for the Assessment of Developments in the Health Care System, the managing directors of the WIdO and ZI as well as some representatives from patient representatives. The petition is supported by the German Network for Health Services Research, the German Society for Health Economics and the Society for Drug Application Research and Drug Epidemiology. With the end of the signing period for the petition on December 3rd. The reins of action are now back in the hands of the Bundestag. However, if one sees health services research not as an end in itself, but as a prerequisite for improving the quality of care for the benefit of patients, then the Bundestag's decision should actually be clear. <<