Strengthen Morbi-RSA's resistance to manipulation
02.03.2016 10:04
The Federal Insurance Office has determined which disease selection will be used as the basis for the morbidity-oriented risk structure adjustment (Morbi-RSA) in 2017. Before the introduction in 2009, there was a political decision to weight the frequency of a disease in relation to the cost via the root function. The Federal Insurance Office is now using this calculation method unchanged for 2017. For Dr. Hans Unterhuber, CEO of the SBK Siemens company health insurance company, it is time to put the decision from back then to the test.
The IGES Institute recently presented a scientific evaluation of the disease selection in a report. Due to the strong weighting of the prevalence, i.e. the frequency, so-called common diseases in Morbi-RSA would be given financial preference, which occur frequently, are not excessively expensive and are accessible to prevention. Very costly illnesses that are more fateful are left out.
What is also striking is that since these common diseases were included in the Morbi-RSA, the number of affected patients with corresponding diagnoses has increased significantly. While 470,000 patients were suffering from obesity in 2013, two years later 1.1 million people are affected. Is this increase being forced by Morbi-RSA? The scientists at the IGES Institute showed relevant indications that urgently need to be investigated. The goal must be a neutral system that offers no incentives for influencing.
More distributive justice
The IGES experts recommend less consideration of prevalence by weighting according to logarithm. According to the SBK, this solution would be an important step for fair fund competition, because the ratio between expenses and allocations, the so-called coverage ratio, currently varies significantly depending on the type of fund between 99 percent (IKK) and 101 percent (AOK). This difference of around 2 percentage points in the coverage ratio corresponds to around 0.3 contribution rate points. A changed weighting of the prevalence could be a building block to equalize unjustified excess and undercoverage. More distributive justice ensures fair cash competition.