Original article
„"Now, for an initial five years, Knieps will help the company health insurance funds rebuild what he demolished as a top civil servant," wrote the Frankfurter Allgemeine Zeitung (FAZ) on its online portal. "Monitor Versorgungsforschung" spoke with the former managing director of policy at the AOK Federal Association, later head of the "Statutory Health Insurance, Long-Term Care Insurance" department at the Federal Ministry of Health and Social Security, and, after leaving the BMG, partner at the business and political consultancy Wiese Consult, about fundamental political, economic, and social issues he intends to advance in his new position as chairman of the newly founded BKK umbrella association.
28.05.2013
Sensor-assisted pump therapy (SuP) has existed since 2006 by combining insulin pumps and continuous glucose monitoring, or CGM for short. While this new form of therapy is being prescribed to a much greater extent, especially for type 1 diabetics in other European countries, there is already general reimbursement in the Netherlands, Switzerland, Israel, Slovenia, Sweden, Ireland, Slovakia, Estonia and Austria exists, penetration in Germany is rather low. Because CGM is currently not reimbursable in this country - so each health insurance company decides on a case-by-case basis. On November 23rd last year, the G-BA commissioned IQWiG, which published a preliminary report plan on “Continuous glucose measurement with real-time measuring devices” on April 18th this year, which was published on July 20th after a hearing on July 9th. was finalized in October. This is now the basis of a preliminary assessment that will be published in the first quarter of 2014, which will then be submitted for hearing again. Only then – in the third quarter of next year – will the G-BA decide on reimbursement eligibility.
28.05.2013
The effects of demographic change have prompted the DGbV to set up a working group called “65 Plus”. Last but not least, the DGbV calls for a stronger citizen-oriented approach to older, particularly mentally or physically impaired citizens in the German healthcare system. The newly formed group serves two purposes. On the one hand, people over 65 who are still fit should be encouraged to continue to do everything in their power to get many more fulfilling years out of their lives. On the other hand, older, multimorbid and polypharmaco-treated citizens should also be protected from damage caused by over-, under- or incorrect care. Three experts spoke about the second set of topics at a “65 Plus” kick-off event in Berlin.
28.05.2013
„"According to the coalition agreement between the CDU/CSU and SPD, the manufacturer's discount is not to be reduced to 6 percent as legally stipulated on December 31, 2013, but rather increased to 7 percent. In return, the existing market calls within the AMNOG procedure are to be discontinued. Both proposals appear, on the surface, to be rather trivial political deals, but they have a legal dimension that could pose difficulties for the new government – should this proposal be enacted into law. This would be the case if the new government does not act proactively and – with regard to the manufacturer's discount – quickly enough. This is the opinion of Prof. Dr. iur. Dr. med. Alexander PF Ehlers, Managing Partner of the law firm Ehlers, Ehlers & Partner, Munich.".
28.05.2013
At the 4th discussion forum "Market Access & Health Economics" organized by Thieme Verlag - in media cooperation with the MVF sister medium "MA&HP" - a number of speakers offered documentation of what the AMNOG process represents in real terms - which, however, comes from the presented very differently from each perspective. A highlight was the lectures by Josef Hecken, the impartial chairman of the G-BA, and Dr. Antje Haas, head of the medicines and remedies department of the National Association of Statutory Health Insurance Funds, the lectures by Prof. Dr. Dieter Cassel, Emeritus for Economic Policy, Health Economist and Representative for International Programs at the Mercator School of Management at the University of Duisburg-Essen, and Dr. jur. Manfred Zipperer, the impartial chairman of the arbitration board according to Section 130 b Paragraph 5 SGB V. The latter both asked “Monitor Healthcare Research” for a joint interview, as all sorts of points had to be discussed in their presentations.
28.05.2013
Once the Institute for Quality and Efficiency in Health Care (IQWiG) has completed its work and the Federal Joint Committee (G-BA) has published its decision, the pharmaceutical company and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) have six months to agree on a reimbursement price, which is essentially a discount. If the parties cannot reach an agreement, one of them must appeal to the arbitration board established under Section 130b of the German Social Code, Book V (SGB V). Its impartial chairman – Dr. Manfred Zipperer – and his arbitration board members, who, like him, serve on a voluntary basis, must then submit corresponding arbitration rulings within three months. However, health economist Prof. Dr. Dieter Cassel (discussed in detail in the upcoming issue of "MA&HP" and in the interview starting on page 18) views these rulings with considerable skepticism.
28.05.2013
Coinciding with the Thieme Discussion Forum, which this year focused on "Existing Market and Quality of Care," the first results of the coalition agreement from the Health Working Group were announced. The current plan is to discontinue the call for proposals for existing market products. Josef Hecken, impartial chairman of the Federal Joint Committee (G-BA), addressed these potential changes directly in his presentation, stating that he considered this decision a "gratifying outcome." He explained that he had not only foreseen legal problems with such an existing market assessment but also feared "extremely negative consequences for the reality of healthcare provision in Germany." Hecken further emphasized that the G-BA will place greater emphasis on the quality of life factor in future benefit dossiers. Dr. Antje Haas, Head of the Pharmaceuticals and Medical Devices Department at the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), ventured a look into the proverbial crystal ball, exploring the question of where pricing might develop in the future. According to Haas, a uniform European procedure for benefit assessment could be established in the distant future.
28.05.2013
After almost three years of AMNOG and numerous findings from the benefit assessment processes, the first interim conclusions can be drawn with regard to the market penetration of evaluated active ingredients. 62 preparations have now completely gone through the early benefit assessment process, of which 11 active ingredients were certified as having significant added benefit, 20 active ingredients as minor and 5 active ingredients as having non-quantifiable additional benefit. The existence of such an additional benefit and its extent are crucial for the subsequent price negotiations and, if necessary, also for successful market development. With regard to patient care, the regional market penetration of new drugs plays a major role.
28.05.2013
Anyone who has worked through a few hundred posters and not many less lecture abstracts that were presented in realiter at the 12th German Congress of Health Services Research (DKVF) will recognize one thing: the field of health services research as a sub-area of health system research is a highly complex one, but equally so a highly divergent one. This ranges from posters like “Then you’re crazy because you dream about Nutella” (Palant et al.) and “What helps against a hangover? - A systematic review of interventions for the prevention and alleviation of Veisalgia” (Messer et al.) to many quality works, which were awarded the German Network Poster Prize, among other things. And to various lectures in many tracks, which are actually much too good to have only found a few dozen listeners, and are therefore quoted here in a very small selection, excerpts, but without wanting to diminish those not mentioned. The crowning finale was the “Health Care Research Meets Politics” event, to which the Bertelsmann Foundation and the German Network for Health Care Research (DNVF) invited.
28.05.2013
The 12th German Congress for Health Services Research (DKVF) took place for the first time from October 23rd to 25th together and also parallel to the German Congress for Orthopedics and Trauma Surgery (DKOU) in Berlin. The organizers were the German Society for Orthopedics and Orthopedic Surgery (DGOOC), the German Society for Trauma Surgery (DGU), the Professional Association of Specialists in Orthopedics and Trauma Surgery (BVOU) together with the German Network for Health Services Research (DNVF). “Monitor Health Services Research” spoke to the congress presidents and scientific leaders Prof. Dr. Karsten Dreinhöfer (BVOU and DGOOC) and Prof. Dr. Edmund AM Neugebauer (DNVF).