No deviation from the RSA procedure despite “significant need for research”
26.09.2011 12:20
Already on June 22, 2011, almost three months ago, the Scientific Advisory Board presented the final version of its “Evaluation Report on the 2009 Annual Adjustment in the Risk Structure Adjustment” to its client, the Federal Ministry of Health (BMG). After a few months it became too much for the health insurance companies and they insisted that the delay caused by the change in the health minister was no longer acceptable. Lo and behold: the 393-page work was published within the suggested time.
The content does not explain the delay, because after their many analyzes the experts have come to the conclusion that there is currently nothing to change in the current RSA system, despite a lot of criticism from individual health insurance companies. “In view of the results for the model alternatives analyzed, a deviation from the current procedure is not appropriate in the opinion of the Scientific Advisory Board,” explained the professors Dr. Saskia Drösler, Dr. Joerg Hasford, Dr. Marion Schaefer, Dr. Jürgen Wasem and Prof. Dr. Eberhard Wille and Dr. Bärbel-Maria Kurth. Purely empirically, a stronger morbidity link in the allocation of administrative expenditure would be indicated, but since the financial impact of changes resulting from a change in the distribution key was comparatively small with a total volume of administrative costs of "only" 8.68 billion euros and in view of the fact that a correspondingly changed key only brings with it a slight increase in target accuracy - but without resolving the fundamental problem of the significantly lower target accuracy compared to other allocation components - the Scientific Advisory Board recommends sticking to the existing key. But even after writing the 393 pages, it is obvious to the Council that “there is still a considerable need for research” regarding the possibilities for standardizing sick pay periods and the associated expenses. Specifically, the question should be addressed as to whether and to what extent the models can be further improved by including the previously mentioned influencing variables (activity of the member, industry, level of employment, duration of continued payment of wages in the event of illness, amount of individual income subject to contributions). or whether other variables can be identified that also help to explain sick pay cases, sick pay periods or sick pay expenses. It is also of general interest whether treating “regular” sickness benefit cases and cases involving child illness separately can lead to significant improvements in the quality of prediction. From purely pragmatic considerations, the question arises as to how the existing classification model can be converted into a model for predicting periods of sick pay in a targeted manner and without major effort, in order to be able to validate the conclusions drawn in this report using a more specific model for standardizing sick pay .
The AOK has already welcomed the publication. “The report now confirms that the introduction of the Morbi-RSA on January 1, 2009 was absolutely correct,” explained Jürgen Graalmann, the deputy chairman of the AOK Federal Association in Berlin. It is now clear once and for all that “the prejudices against M-RSA that have often been expressed in the past simply cannot be empirically supported.”