>> These adjustments include, among other things, the transferability of funds, which was negatively approved in the last legislative session, which, according to State Secretary Lutz Stroppe, is being discussed again, as he said in August 2018
G-BA Congress “Two Years of Innovation Fund” was recorded. This also includes “actually learning from experience,” as Spahn put it. The question should be addressed as to “which details need to be adjusted in the future and, above all, what can be laid out more regularly so that good things also come into the standard care system”. This will include, among other things, an evaluation of the innovation fund as such, which the economic research and consulting company Prognos, which has been commissioned to do so, will present to the German Bundestag in March 2019.
However, this will only - according to the planning - be an interim report, which will contain, on the one hand, an assessment of the innovation fund as a policy instrument and, on the other hand, recommendations for action to strengthen its effectiveness. The final report, which will not be presented to the Bundestag until March 2021, should contain the actual potential of the funded projects that can be evaluated by then to further develop care in line with the goals of the Innovation Fund and - even more far-reaching - represent the true impact of the Innovation Fund on care .
The problem is that Prognos will and can only rely on the interim or final evaluations available up to that point, which the applicants must publish. Where and how this publication will take place is not exactly specified. The current “General Additional Provisions” (ANBest-IF), which the G-BA’s Innovation Committee has set itself for funding from the Innovation Fund, only states that the “funding recipient is obliged to report the result – at least in the factual content of the final report – to make it accessible to the specialist public in the Federal Republic of Germany in an appropriate manner within six months of completion of the project.” In addition, the sponsor, i.e. the Innovation Committee, would also publish the results report of a healthcare research project (VF) and the evaluation report for a project on new forms of healthcare (NVF).
However, only those results that come from the 30% projects supported by the Innovation Fund can be published - whether these are positive or negative in their respective final evaluation, as hoped; although the latter will normally be the case.
Here, the positive-thinking Prof. Josef Hecken, impartial chairman of the Federal Joint Committee and at the same time chairman of the Innovation Committee, set the rate of positively evaluated projects low and pragmatically at the G-BA Congress: In his opinion, 15 to 30 percent of the funded projects should be so successful that they end up in care - whether in the form of integrated contracts, within DMP or in standard care remains to be seen. Hecken: “My metric is not that 100 percent is included in standard care, that would be absurd,” because research also consists of recognizing that some things don’t work.
Now what about all the project approaches that were rejected in the selection process? Are there perhaps (or perhaps) hidden in these 70% unfunded projects many ideas, concepts and approaches that would also be able to further improve the quality of care in Germany? It is unknown whether this is the case, as so far all those projects that have been rejected are no longer allowed to be viewed publicly. The reason: Neither the project applicants, nor the titles, let alone the ideas and approaches behind them, nor the project partners involved are transparent at any point.
In response to a request from the trade journal “Monitor Healthcare Research” (MVF), which asked for an insight into all innovation fund applications – including those that were rejected – the G-BA announced in writing: “Applications to the Innovation Committee are not made publicly and can be viewed by everyone. but confidential. Applicants rely on the fact that only the information that they have agreed to be published will be published in the context of their applications, which contain personal data and intellectual property or business or trade secrets. This procedure is in accordance with Section 6 of the Federal Law regulating access to information, according to which there is no right to access to information if this conflicts with the protection of intellectual property. Access to company and business secrets may only be granted if the person concerned has consented.”
Of course, the Innovation Committee could change that by amending its “ANBest-IF” and making future funding decisions dependent on that
a) either all information on submitted funding projects is entered in a publicly accessible register, or
b) the applicant is left to decide whether he would like to make at least the most important project information accessible and thus additionally receive a kind of protection of ideas in the manner of utility model protection.
In any case – according to an expert interviewed by MVF – “it would make sense to also publish the titles of the projects that were considered but ultimately not funded.” In any case, in addition to a scientifically sound synopsis, the basic data of the applications (year, title of the application, standardized assignment of diseases according to ICD 10, information on the topic of care and indication area according to ICD 10, institution, contact person/data) should be listed.
This would have the advantage that, on the one hand, interesting projects would be known at an early stage and, on the other hand, potential project partners willing to participate could find each other more easily than before. And as a further bonus: on the basis of the resulting transparency, it could be discussed publicly whether a rejected project was rightly rejected. This may have reasons that have nothing to do with the quality of the idea behind it. To understand this, however, one must delve deeper into two complex worlds; on the one hand in the funding system of the innovation fund, and on the other hand in the logic on which it is based.
The funding system
The funding system of the innovation fund is determined by the innovation committee's two-, actually three-stage decision-making model. The legal basis for the work of the Innovation Committee set up at the G-BA is Sections 92a and 92b of Book Five of the Social Security Code (SGB V). The Innovation Committee, which has eleven members in accordance with Section 92b Paragraph 1 SGB V, determines the priorities and criteria for allocating funds from the Innovation Fund in the respective funding announcements and ultimately decides on the funding applications received. The Innovation Committee itself has decided how it does this in rules of procedure approved by the BMG. This regulates in particular what the tasks, composition and appointment of the members of the Innovation Committee should look like, what formalities of resolutions - such as voting rights and their distribution - must be observed, what the appointment and working methods of the working committees should look like, what tasks the office should have and which ones the commissioned project sponsor should take over, and also what the expert advisory board's working methods should look like in cooperation with the innovation committee.
Which projects are eligible for funding is regulated in a set of rules drawn up by the Innovation Committee itself and again approved by the BMG. This defines what the application and funding process should look like, how the determination and publication of funding announcements is defined; but also who the eligible applicants are and what the criteria and procedures for evaluating the application are, including how the expert advisory board works.
The expert advisory board appointed by the Federal Ministry of Health has the task of bringing scientific and practical healthcare expertise into the Innovation Committee's advisory procedures. The volunteer expert advisory board does this with a very complex, very time-consuming assessment of the project applications received.
The Innovation Committee recommends that applicants contact the project sponsor before submitting an application. The project sponsor is the Association of the German Aerospace Center (DLR), which was commissioned by the Innovation Committee to handle the funding measure. Among others, the German Network for Healthcare Research (DNVF) eV had well-founded its support for the appointment of a project sponsor who was at least experienced in basic research.
The DLR provides applicants with an advice hotline, through which – as Hecken explained at the G-BA Congress – more than 10,500 “intensive phone calls with applicants” have already been made to discuss detailed questions. Furthermore, 7 webinars with over 1,300 participants and 2 more on ongoing projects with over 400 participants were held, and over 150,000 forms and documents were downloaded from the Innovation Fund website (all figures: as of August 2018).
Also as of August 2018, the event month of the Innovation Conference
gresses of the G-BA, according to Heckens, 914 applications were processed and 1,498 legally binding notices were issued, since in addition to the funding notice, further notices may be required when it comes to changes within a project that require approval. In the meantime (Table 1), 55 more new projects on health services research (VF) and 39 projects on new forms of care (NVF) have been added, with the funding rate for VF (200 in this wave) submissions being the same as the previous 30%
has remained, however, with the NVF on a good 40%
increased because “only” 93 applications were submitted this time, meaning that the funding amount available in this wave could be better utilized.
In total, since 2016 - the start of the innovation fund - 389 applications have been submitted in the area of NVF and a further 529 applications in the part of health services research (VF). Of these, 120 NVF projects and 173 VF projects were approved and thus supported by the innovation fund. This raises the question again: Are the projects that have received positive reviews so far really the right ones that are able to sustainably improve care? An expert interviewed by MVF says: “If you are already active in a public funding sector that is organized with penalty payments, you also have to make an effort to not only have sufficiently good ones, but also the
to promote the best innovation ideas.”
When answering this rather difficult question, it must be clear that the declared aim of politics is to use the innovation fund to support, in particular, projects that improve cross-sectoral care and that have implementation potential, as well as those whose goal is the long-term further development of selective contracting supply is.
However, it will only be possible to say whether the goal of the long-term further development of selective contract care will actually be achieved when the final evaluations are published and it is clear what such an implementation/translation might actually look like. However, based on the funding decisions that have so far been positive and published in short form, one can already doubt that there are enough projects that could improve cross-sector care.
According to an evaluation carried out in 2018 by the Berlin knowledge management company Ordinary People, the topic specifications of the individual funding waves have no comprehensible contextual connection to cross-sector care. Only ten projects have the term (including cross-sector coordinated) in the title, another five mention the terms “transsectoral”, “multisectoral” or “intersectoral”:
• Avenue-Pal – Analysis and improvement of cross-sector and cross-departmental interface and transfer management in palliative care
• Dent@Prevent – Implementation of routine data & PROMS in evidence-informed intersectoral (dental) medical care
• EMSE – Development of methods for using routine data for cross-sector discharge management
• GerNE – E-Health-based, cross-sector geriatric care / geriatric network
• Herzeffekt MV – Development and specific construction of a cross-sector care center to optimize the care of chronic heart diseases in MV
• INDEeD – utilization and cross-sector care patterns of patients in emergency care structures in Germany
• isPO – integrated, cross-sector psycho-oncology
• MSTVK – Development and implementation of a multimodal, cross-sector and cross-carrier care concept for major amputation
• PROMISE – Process optimization through interdisciplinary, cross-sector care for hip and knee arthrosis
• PsychCare - Effectiveness of cross-sector care models in psychiatry - a prospective, controlled multicenter observational study (PsychCare)
• RECOVER – model of cross-sector coordinated, severity-graded, evidence-based care for mental illnesses
• RemugVplan – Regional multisectoral geriatric care planning
• Cross-sectorally organized care for complex chronic illnesses: stroke guides in East Westphalia-Lippe
• TELnet@NRW – Telemedical, intersectoral network as a new digital structure
• TIGER – Transsectoral intervention program to improve geriatric care in Regensburg

According to Ordinary People's assessment, the cascade of topics is, on the one hand, inscrutable, and on the other hand, despite the specifications of the calls for proposals, it is rather research-oriented.
driven. There are also a variety of “project duplications” and overlaps. The problem: In OP's opinion, without (supply) target projects and standardized project management and implementation conditions, a transparent, comparative and controllable project landscape can neither be set up nor clearly assessed.
It can therefore be assumed that the actually intended goal of cross-sector care, which really improves care, can only be achieved marginally.
This in turn has two reasons. The first: “While in a clinical study only the study results
requirements must be observed,
“Interventions in everyday care generally require a lasting change in processes and structures, and thus often also in everyday routines,” write the expert advisory boards in their article “Reflections of the Expert Advisory Board on Applications under the Innovation Fund” (3). In the article you point out that scientific and practical experience shows that this often does not work - “one reason for this can be resistance to change”. The expert advisory board therefore recommends an “explicit implementation strategy in the study phase and in the period after the study”, which can ensure “that the intervention is not rejected like a foreign body, but rather accepted and accepted”.
The second reason is simply that there are only two handfuls of funded projects that focus on cross-sector care – at least in part.
Why is that? Because there were too few submissions that wanted to take up and tackle this goal, which has been given top priority by politicians? The problem: The question cannot be answered because rejected applications with reference to the protection of ideas intended in Section 6 of the Information Act are not published.
But why could applications that aim to improve cross-sector care - if they even existed in sufficient quantity and quality - have been rejected?
To this end, “Monitor Healthcare Research” interviewed some applicants and project partners who have an overview of accepted and rejected applications and can therefore compare them.
Now one could assume that when answering the question, it would also be helpful to take a look at the rejection notices, which, however, only exist from the second wave of funding. However, the rejection notices are not publicly available.
They would also probably have only limited utility value. This is primarily because, as one of the experts interviewed by MVF explains in individual interviews, the rejection notices are formulated in a legally effective manner. This means: On the basis of these declarations regarding the rejection of the respective funding application, an applicant can take legal action against the Innovation Committee. Two applicants did this - but without success.
This low number of legal proceedings compared to the number of submissions makes it clear: the innovation committee at the G-BA naturally drafts the rejection notices in such a way that the applicant (or their lawyers) does not have sufficient starting points. The Innovation Committee sometimes does this in such a way that – according to one of the experts interviewed – “the submitter has the impression that it was an impudence that he submitted at all”. “Any weak points would be harped on in order to find the most legally sound justification for the rejection”.
This will often have very little to do with the real reasons for rejection. For some of those surveyed, it was even the case that their favorite project, which they were absolutely sure would, on the one hand, have a clean methodological approach and, on the other hand, improve care - at least for certain subpopulations - did not receive funding from the Innovation Fund is. This happened for a variety of reasons, some of which were understandable and some of which were completely non-transparent.
The logic of the innovation fund
How is an application processed in the Innovation Fund funding system? The application must be submitted to the project management agency DLR via an online portal (4) after publication of the call for proposals by the Innovation Committee (1) and the DLR (2). This examines the application according to formal criteria, including completeness and the existence, perhaps also consistency, of the evaluation concept. Applications that have overcome this first hurdle go to the Innovation Committee and the 12-member expert advisory board (5). This was appointed by the BMG under the then Federal Minister of Health Hermann Gröhe and has not changed personnel since then. It includes scientists who come from health services research as well as from direct patient care and teaching, but it also includes a hospital boss and a former prominent health insurance manager.
Given the number of submissions, applications are not assessed by the full plenum of the expert advisory board due to capacity reasons, but two members are always entrusted with the initial assessment for each application. This can lead to different constellations. But first and foremost, the expert advisory councils confronted with an application must declare whether they are biased. A first weak point is hidden here: What is biased? Is it enough if an expert advisory board knows the applicant, which will certainly often be the case? Previously worked with the applicant, belonged to the same professional society or club? Or do there have to be clearer conflicts of interest in order to have to declare bias - for example, that the expert advisory board or its employer is involved in the project itself? Only when the “bias” has been clarified will the application be assessed. Now it may be that
a) a methodically perfect application with a small probability of implementation comes to two expert advisory boards who are enthusiastic about the methodology but pay somewhat less attention to the possibility of later translation (methodology more important than usability)
b) an application that really improves care and has a high probability of being implemented, while an application that is not so methodologically clean is assessed by two expert advisory boards who are enthusiastic about the idea and therefore put the quality of the methodology second (usability over methodology).

If both experts come to the same conclusion, the application is submitted directly to the Innovation Committee for a decision with a positive or negative assessment (which is not published). However, if both experts do not come to the same conclusion, the entire plenary session of the expert advisory board must deal with the project in question and come to a unanimous decision (which will not be published). The application then goes to the Innovation Committee for a final decision.
One of the expert advisory boards surveyed says of his own work: “At least the worst applications are not funded.” However, another scientist surveyed points to quite a few positive applications that are either “characterized by hopeful ignorance” or simply “im cannot be implemented in the actually existing supply system. “Many people came together there, those of the complex ones
"We are not familiar with the mechanics of the funding process," another respondent from the cash register scene points out. Although the applicants “received a lot of money, they are unable to implement the projects appropriately because money does not undermine the legislation”. There is another fact: Until now, the cash registers were essentially the guardians of the money to be spent on insured people, but according to the funding guidelines, this is now the project sponsor, who, according to the expert interviewed, has no idea about social legislation.
In the first wave of funding, the expert advisory board - all volunteers, mind you - put a lot of effort into its assessments, but the innovation committee often deviated from this assessment in both directions. How often and why this happened is unknown (because it has not been published). This means: An application can be funded even though the expert advisory board is against it, another application cannot be funded even though the expert advisory board has given a positive assessment. However, that changed from the second wave of funding onwards because the expert advisory board intervened in the Innovation Committee and insisted on its valuable evaluation work; Since then there are said to have been no more deviations.
This approach can now be viewed from very different perspectives, where there is no right or wrong:
a) Is the project worthy of funding if it is based on a high methodological gold standard?
b) Is the project that is able to sustainably improve care worthy of funding?
c) Is the project worthy of funding that may not meet the gold standard, but provides the G-BA with sufficient evidence for a practical decision to change a detail of care for the better?
d) Is the project worthy of funding that – when it comes to the as yet undefined translation into standard care – will not trigger a stopping veto from the banks involved (or even just one of them)?
These questions alone make it clear that the funding or rejection of an innovation fund project does not only have to have to do with the quality of the project or the idea as such. It will always be a compromise decision, with each proposal subject to the play of forces; namely the influences of the “benches” active in the G-BA (6), formed by the GKV umbrella association and the umbrella organizations of service providers DKG, KBV, KZBV, which are in the same constellation (but here supplemented by a representative of the BMBF and two of the BMG ) are active in the Innovation Committee (7).
The latter is an absolute novelty in self-government, which otherwise refuses to integrate politics into its committees. Hecken argues here that it makes absolute sense to include the representatives of the ministries in the Innovation Fund Committee, as the legislature may be required to do so in the course of the planned later transfer of positively evaluated projects. Hecken said in the MVF cover interview (01/17): “It is a paradigm shift that is associated with the innovation fund. Improving care across the board is the main goal, which can only be achieved if everyone responsible is at the table. If the parties that run the G-BA and also the Innovation Committee decide in a unanimous selection process in the presence of two federal ministries those projects that they themselves assume are suitable for standard supply, it will be easier after four years also to ensure translation” (8).
Each of the top performance organizations
Health care providers - but of course also those of the health insurance companies - have their own agenda, sometimes a hidden agenda, but often a quite obvious one. Now it would be too simplistic to say that a project would only be rejected by a “bank” because it could cause loss of income or political disadvantages for the clientele it represents, or simply exceed the overall budget of the GKV, no matter how sensible the goal may be.
Possible reasons for rejection can be much smaller and more specific. For example, in which the representative of one of the “benches” feels not included and ignored because someone, let’s say, outside the system, presumes to take care of a core area that is part of the causal field of activity and also the field of identification of the service provider (or the cost bearer) for which the “bank” in question is responsible. However, they did not pay sufficient attention to the relevant detailed question, as the project in question points to this apparently still real quality deficiency and wants to remedy it. For this reason alone, a veto can be issued by the “bank” in question. However, there is probably a different reason given, which is not subject to publication.
Reasons for rejection are therefore likely to be found quite quickly for all those projects that run counter to the goals of a “bank” or do not fit into its strategy. This is likely to affect most cross-sector projects, because if they were successful, they would endanger the current sectoral division and remuneration, with which many self-government “benches” have come to terms quite well.
What happens to an application to which a “bench” representative says before the decision-making consultation: “Even if the project proves successful, I will veto it if it is to be implemented afterwards!” Is this project funded? Even though everyone knows that a veto announced in advance will have almost a stopping effect?
Now it is the case that, theoretically, a single “bank” in the G-BA plenum can be overruled by the others when it comes to a possible, because it obviously makes sense, implementation in the standard provision. But when in doubt, all “benches” have one or even several projects that they would rather not see realized for a variety of reasons. “The principle applies in advance of certain decisions that the veto players agree on packages,” explains one of the cash managers interviewed, who is pretty sure that negotiations in the G-BA follow the following pattern: the DKG wants three specific projects not, the KV not three others and the central association not three others. The expert interviewed: “So you already have nine projects that will definitely not be implemented.”
The crux of the matter is that it is precisely the projects with high potential for improvement that could become unpleasant for the “banks”.
A crucial question: Does it even make sense to support such projects?
The answer could be positive if the healthcare system - especially its
Protagonists – would be willing to change. However, because they are not on a large scale, from the perspective of the contributors (who finance the innovation fund with many millions, which are therefore deprived of supply), it could well be better to have projects that cannot be implemented afterwards anyway or are not viable in the actually existing system will not be promoted at all. As long as - according to an expert - benches in the G-BA have a seat and a voice and can say, “we don't agree to that anyway”, the continued existence of such projects, even the best ones, is a “waste of insured people's money”.
This again leads to the question: Are the 30% of the funded projects really the ones?
best or not?
The answer: Unfortunately, we don't know. It is precisely for this reason that it makes sense to publish the funded projects (including the decision history) in an online-supported knowledge database. Then cross-connections could be made and anomalies discovered, which is hardly possible in the PDFs that have so far been put online by the Innovation Committee because the evaluation is too complex: You can scroll through the PDFs to read one page per project one after the other, but nothing more . On the other hand, the rejected project applications must also be published so that the public, especially the community
From science, providers, politicians and patient representatives, we find out which projects and ideas with potentially high potential for improvement are in danger of disappearing - if they are not resubmitted to other third-party funding sources.
Which can certainly be a reason for a deliberate non-publication; or as one scientist interviewed said: “Ultimately, this is about ideas that are not protected.” By the way: In the beginning, it was an absolute “no go” at the Innovation Fund to support a project that had already been rejected elsewhere. But over time this was no longer seen so closely.
What needs to be discussed is what information is possible, but above all necessary and useful, in the context of Section 6 of the Information Act. This should include the name and institution of the submitter, the consortium partners and, above all, a synopsis that is as well-founded and standardized as possible. One of the scientific experts interviewed even goes so far as to not only demand that “the sum of all applications to the innovation fund be used” in the future, but also advises that a basic funding requirement be that “an abstract limited to 400 words, for example must be written with two relevant literature citations and contain all the necessary information required for a reliable assessment. The assessment should then not be carried out by an expert advisory board, but rather a kind of peer review, involving the largest possible number of experienced experts.
What might the required information look like? A scientist interviewed designs a two-stage model:
1. Political dimension: If completed positively, does the project potentially contribute to improving care? The possible improvement must be presented in plain text and generally understandable.
2. Scientific dimension: Can the question formulated be answered using the methods described? If yes how?

According to the scientist, both answers must be justified with a few valid arguments and then signed by the project manager and the already named evaluator. The reason: With the new forms of care, it can be assumed that the first question can be answered on the basis of care competence, while the second question can only be answered on the basis of very profound scientific, particularly methodologically precise competence.
Another scientist interviewed on this topic refers to experiences he has had with EU innovation projects. He mentions, among other things, the “European Cooperation in Science and Technology” Network (9), an international multi-stakeholder funding network
work in which many political decision-makers, civil society, but also the private sector are involved. The members have founded the joint, international and non-profit COST association, which publishes calls for proposals on a wide variety of topics (including health), although it is not only possible to submit very structured individual applications, but also to take part in ongoing actions can be further expanded over the normal financing period of four years. It is important that the offer evaluation for eligibility not only takes place on the basis of a proposal by the scientific committee with subsequent application approval by the CSO (Committee of Senior Officials), but also is assessed by independent external experts and ad hoc review committees based on the following evaluation criteria: Science & Technology Excellence (maximum 15 points), Networking Excellence (15 points),
Impact (15 points) and Implementation (5 points). The process for submitting, evaluating, selecting and approving proposals should be “fully science and technology driven” and ensure a “simple, transparent and competitive” proposal evaluation and selection process that follows bottom-up, open and inclusive principles of COST. In other words, everything that is still missing from the innovation fund in its current form.
Of course, such peer review procedures also have disadvantages in addition to advantages. What is needed – according to another scientist interviewed – is, on the one hand, a “transparent evaluation process that also uncovers nepotism”, but above all an “alternative system” in which not only health care researchers are involved, but above all also those actively involved in real care as well as experienced fund managers contribute their perspectives.
But this brings us almost back to the composition of the Innovation Committee and its expert advisory board. However, an additional possibility would be to supplement the current decision-making system with a type of arbitration board, as is the case with AMNOG (10), for example. However, the law would have to be changed accordingly. The BMG would then have to initiate this.
The governance
Another problem that has already become apparent due to the hidden agenda issue is the installation of the Innovation Committee at the G-BA, as regulated in Section 92b SGB V. Whether this is actually a problem depends on your perspective.
Of course, it would be possible to withdraw the Innovation Committee from the G-BA's direct access, but to do this would first have to change Section 92b accordingly, which already makes a clear classification in the title because it is titled: “Implementation of the promotion of new forms of care for the further development of healthcare and healthcare research by the Federal Joint Committee.” If the legislature had wanted a different allocation of the innovation fund and its committee, the paragraph would have been titled differently. Now assigning the Innovation Committee to – let’s say – a more independent environment than that of the G-BA would have its advantages; but also disadvantages.
The Joint Federal Committee, established in 2004 with Section 22 of the Statutory Health Insurance Modernization Act (GMG), took over the tasks of its predecessor organizations and thus those of the former federal committees of doctors/dentists and health insurance companies, as well as the Hospital Committee and the Coordination Committee (11). Since then, the G-BA has determined “what is beneficial and harmful to the supply” (quote from an expert interviewed). As long as that is the case - although there are signs of a first change in the TSVG currently under discussion - in the words of the expert, “the subordinate logic of the Innovation Committee must follow the basic logic of the G-BA, which results from the corresponding law”.
Anyone who adopts this possible perspective must also admit that it also affects science that deals with money
efforts from the Innovation Fund must also recognize this logic. The expert: “If the innovation fund is intended to adequately spend the insured people’s money instead of paying for a project that results in a nice impact article, it is exactly the right place for the G-BA.” But then the entire innovation fund, including the committee and Advisory Board and all its funding projects are a kind of “assistant work for the G-BA”, which puts them in the same ranks as the IQWiG or the IQTIG. The expert: “That’s exactly why you can’t just have the gold standard in mind here, but you also have to properly block projects that won’t stand a chance in the end anyway.”
In addition, anyone who agrees with this logic - the Innovation Committee as a preparatory unit for G-BA decisions - will inevitably come to different results than those who feel connected to the scientific logic.
Anyone who wants to research more freely as a scientist would have to apply for funding from the BMBF, although it is clear that any research funding aimed at application will be a compromise. “A scientist who agrees to use funding to support a system that is not committed to the truth, but to money and power, has to accept that decisions will be made differently,” says one expert interviewed.
Conclusion
If politics is effective in its funding
If you want to change things, you would have to consider which main goals (that would be a big, additional topic, namely that of “supply goals” (12)) an Innovation Fund 2.0 should be based on and how it could be reorganized. This means that it should not only become more transparent and efficient, but perhaps even offer a kind of utility model protection for published ideas.
Above all, it must be defined how a reasonable adaptation of the innovation fund outside the G-BA - if that makes sense at all - could be conceivable.
How this very ambitious goal can be achieved beyond an innovation fund is completely unclear. In mid-2018, the Federal Association of Managed Care eV presented detailed “recommendations for action on the further development of the innovation fund” (13). Among other things, it mentions that sometimes project applications fail due to formal criteria despite sensible concepts. The BMC therefore demands that “in the case of rejected projects, the vote of the expert advisory board should be communicated, as well as information about whether resubmission of the concept is recommended.
The German Network for Healthcare Research (DNVF) eV specifies the BMC proposal by demanding (14) that the “input of the innovation committee should focus even more on questions of practical relevance and an assessment of the translation potential”. At the same time, in the opinion of the DNVF, the role of the expert advisory board should be strengthened and the “final decision on funding should be made jointly and equally by both bodies”. Conflicts of interest would have to be disclosed, the decision-making criteria should be transparent and the votes – negative and positive – should be published.
The German Society for Telemedicine eV also made recommendations for action in November 2018 (15). The DG Telemed suggests, among other things, that when examining funding applications, an early plausibility check of the projects should be carried out with regard to their structural potential and viability for later inclusion in the statutory health insurance system. In addition, a future focus of the call for proposals should relate to the urgently needed promotion of cross-sectoral and interdisciplinary sustainable supply structures; the resources of the innovation fund should be increased accordingly (approx. 2/3) and used in a structure-related rather than topic-related manner in order to generate approaches to solving the existing structural supply deficits .
The Techniker Krankenkasse, on the other hand, favors a completely different approach. At the beginning of 2018, the TK suggested instead of relaunching the innovation fund
To establish an “innovation budget” (16) to promote new forms of care in the form of a minimum expenditure value of 2.50 euros per insured person. The reason: Initial experience has shown that the current “form of centralized funding” is not able to sustainably resolve the innovation backlog. The problem will be that with this approach every health insurance fund can do whatever it wants and there will no longer be any talk of transparency, including the funding of health care research.
Prof. Dr. Eberhard Wille, deputy chairman of the Advisory Council for the Assessment of Developments in the Health Care System until the end of 2018, considered the budgetary part for health services research “unproblematic” and “certainly justified” at the G-BA congress “Two Years of Innovation Fund” (1), because Germany would lag behind other countries in this area. However, in his opinion, given the much larger budget for the new forms of care, the question should be asked whether they have to be financed via the innovation fund or whether it could be done differently. Because, according to Prof. Wille, the money could also be used for care or nursing, so from this point of view the “legitimacy for this is considerable”.
This makes it all the more important to be prepared to think about how the budget withdrawn from care and used for the pure hope of more evidence can be used in such a way that it comes closest to the major goal of improving health care in Germany. Or as Prof. Hecken – who personally did a lot to ensure that the innovation fund was implemented at all and that it got up and running quite quickly by other G-BA standards – put it at the “Two Years of Innovation Fund” congress in August 2018: That It would be a big fiasco if we “stood there naively in three years and have shot 1.2 billion into the air.” If that were the result, he would be ashamed because – Hecken continued – “that cannot be our goal”.
from:
Peter Stegmaier and
Prof. Dr. Reinhold Roski