Barmer publication: “Health Care Current 2009”

05.10.2009 16:25

Barmer publishes articles and analyzes on structural issues and the future of the healthcare system in a publication

The publication contains the following contributions:

Part I: System issues and competition

What happens after the election? An analysis of the party programs

Paul Raffauf

“After the reform is before the reform”. This basic rule of health legislation may also apply in the 2009 election year. The far-reaching changes as a result of the last reform decisions made implementation only possible in 2009. Now, after just a few months of experience with the health fund and the accompanying changes, the path we have chosen is being put to the test again. An overview of the central content of the parties' election programs reveals similarities but also contradictions that could be resolved within the framework of possible coalition agreements.

The consideration of deceased persons in morbidity-oriented risk structure compensation

Dorothee Schmidt, Dirk Göpffarth

With the further development of the risk structure compensation, more precise allocations are provided for 80 diseases through morbidity surcharges. However, the assignments for deceased persons within these diseases are currently not very precise. For diseases with a high proportion of deaths, this means systematic undercoverage. It is shown how the accuracy of allocations for the deceased can be significantly improved by simply changing the calculation method.

Elective sick pay tariffs – risks and side effects for the solidarity community

Christian Schürmann, Nicole Osterkamp, Kay Amling

The statutory entitlement to sick pay for the self-employed was replaced on January 1, 2009 by the introduction of optional sick pay tariffs. After calculation difficulties on the part of the health insurance companies and significant cost increases for older insured people, this regulation only lasted seven months. In the future, self-employed people will have the opportunity to choose between statutory sick pay entitlement and additional optional sick pay tariffs. The article analyzes the background to the changes.

Social status and morbidity: An empirical analysis based on morbidity-oriented risk structure adjustment

Katja Tebarts

The connection between health status and social status is a recurring topic in the health policy debate. In healthcare, the question arises as to how health status and costs correlate with the level of education. Can diseases that can be influenced here be identified? The article makes a contribution to the current discussion using empirical evaluations of the state of health according to the level of education. 

Risk management from the perspective of a statutory health insurance company

Jens Lüdtke, Vesselka Ivanova

The introduction of the health fund and the associated loss of contribution rate autonomy require the statutory health insurance companies to undertake even more prudent financial planning than before. In the course of the introduction of morbidity-oriented risk structure compensation, planning uncertainty increased at the same time. In addition, the law to further develop the organizational structures in statutory health insurance extended the insolvency eligibility to all health insurance companies and prescribes financial assistance between the health insurance companies. All factors together increase the pressure to implement risk management. This is conceivable both for internal control and as an early warning system within liability communities.

Looking for the healthcare system of the future

Catharina Maulbecker, Nicolaus Henke, Matthias Wernicke

Although health care options are constantly increasing in industrialized countries, dissatisfaction with the systems is growing at the same time. The question therefore arises as to whether healthcare in its current form is still up to date. An international comparison of innovations shows paths to a healthcare system of the future. In addition, the focus on the health sector should be reviewed. The perception is characterized by financial feasibility and supposed cost explosions. In fact, it is also a central economic sector with immense added value.

How do those with statutory health insurance assess the “New World” of the health fund?

Christian Bock, Sybille Kerd

The introduction of the health fund on January 1, 2009 fundamentally changed the structure of statutory health insurance. The regulations made are the result of a political compromise, which, expressed in the keywords citizens' insurance and capitation, included a fundamental debate on fairness. On the basis of a survey of insured persons, the aim is to assess how those affected by statutory insurance assess the result.

Part II: Design of care

Current challenges for hospital policy

George Baum

Even if the names Drug Supply Efficiency Act (AVWG) or Contract Doctor Law Amendment Act are misleading, every health law in recent years always contained a part that had an impact on the financing or range of services offered by hospitals. This also applies to the Statutory Health Insurance Competition Strengthening Act and of course to the Hospital Financing Reform Act. The status quo resulting from the large number of legal regulations as well as demands for future health policy are explained.

Hip arthroplasty: where does the path lead?

Ursula Marschall, Madeleine Worringer, Uwe Repschläger, RainerRiedel

The importance of endoprosthetic care is increasing as society ages. In order to ensure the quality of treatment and also take cost-effectiveness into account, more centralized surgical care will be sought in the future. This intention is supposedly in conflict with the patient's desire for care close to home. The current supply situation in Germany is presented based on the published quality reports from 2006 and BARMER data. Based on this, options are shown where proximity to one's home and center formation can be compatible with one another.

The misfortune of the love triangle: morbidity-appropriate remuneration, coding of medical diagnoses and morbidity-appropriate allocation

Hartmut Günther

The coding of outpatient diagnoses plays a central role in both morbidity-oriented outpatient reimbursement and morbidity-oriented risk structure compensation. The introduction of the coding guidelines was intended to improve the quality, completeness and uniformity of diagnosis coding. However, numerous activities by health insurance companies and associations of statutory health insurance physicians have already been reported in the press with the aim of increasing the number of documented diagnoses. The security against manipulation and reliability of outpatient diagnoses remains questionable, as does the question of the extent to which a new remuneration system can be based on the diagnoses.

The total fees for outpatient doctors in Germany

Uwe Repschläger

The remuneration of practicing physicians is the subject of numerous discussions. Surprisingly, the legally stipulated increase in fees did not calm the situation, but apparently even added fuel to the fire. On the one hand, it's about the amount of remuneration overall, and on the other hand, it's also about the distribution between doctor groups and regions. A shortage of doctors and increasing bankruptcies are also being discussed. However, the numbers speak a different language.

Addiction rarely comes alone - addiction, comorbidity and psychotherapeutic treatment

Ursula Marschall, Walter Ullrich, Christoph Sievers

Addictions are among the most common mental disorders and cause high annual costs, especially for repeated inpatient treatments. In addition to substance-related addictions, those affected primarily suffer from co-occurring psychological illnesses such as depression and anxiety disorders. The treatment of these comorbidities should be a focus of the aftercare phase in the care system for people suffering from addiction, but is only implemented to a limited extent in outpatient psychotherapy. The success of withdrawal and withdrawal treatments can be sustainably secured through psychosocial support immediately after discharge. The example of addiction patients in particular shows that intensive interlinking and networking of outpatient and inpatient treatment structures can result in medically high-quality and cost-effective care.

Empirical connection analysis of drugs and diagnoses and their consideration within the morbidity-oriented RSA

Andreas Wolik

In the morbidity-oriented risk structure adjustment, the legislature required that not only diagnoses be taken into account, but also medications. In the previous implementation, this requirement was met by using a range of drug information exclusively as a test criterion for validating a selection of diagnoses. This article shows approaches to how medically defined relationships between active pharmaceutical ingredients and diagnoses can be supplemented by using a data-driven method - association analysis. In addition to proving the fundamental applicability of this method, there are also initial indications of possible expansions of the assignments used in the context of morbidity-oriented risk structure adjustment.

Link to further information:http://www.barmer.de/barmer/web/Portale/Versichertenportal/Presse-Center/Pressemitteilungen/090826_20Gesundheitswesen_20aktuell/Buchinhalt_20Gesundheitswesen_20aktuell_202009.html