Abstracts by key term: Selective contracts
Healthcare innovations aim to make healthcare better and/or more economical. Important starting points and components (without claiming to be exhaustive) are in particular: process optimization with a view to the entire treatment chain, the development of incentive mechanisms for prevention, remuneration models with a focus on the quality of results and not on the quantity and number of services, and active patient participation.
24.01.2013
Since the health reform of 2000, the health insurance companies have been entitled to conclude selective contracts with service providers. These are family doctor-centered care contracts in accordance with Section 73b SGB V, contracts for special outpatient care in accordance with Section 73c SGB V and integrated care contracts in accordance with Section 140a SGB V. According to the justification for the 2000 health care reform and the law to strengthen competition, the legislature has followed this In statutory health insurance (GKV Competition Strengthening Act - GKV-WSG), these new regulations promise to intensify competition among health insurance companies and improve the quality and efficiency of care1. Within the framework of these selective contracts, the health insurance companies have a wide range of options to deviate from the collective agreement regulations2. In particular, the health insurance companies are entitled to make new examination and treatment methods part of the coverage in the selective contracts.
24.01.2013
On July 1, 2008, the AOK Baden-Württemberg, the General Practitioner Contract Association eG (HÄVG) and the MEDIVerbund concluded the nation's first family doctor-centered care contract (HZV) in accordance with Section 73b SGB V. In this contract, care-relevant quality goals were linked to process management in order to better manage patient care. In order to enable the successful implementation of the contract, comprehensive IT-supported solutions had to be created. The “ICW core” as a software module without its own user interface for integration into the practice management systems (PVS) as well as a telematics infrastructure for connecting doctors online played an important role here. Extensive practical experience has been gained in the last two years.
23.09.2012
The development in health care includes the implementation of contracts between different players as one of the main regulating factors. Contracts don't run by themselves; it's not enough to agree on content and sign it. The evaluation must be taken into account and planned as early as when the contract is concluded, and not only after 3 years, but continuously and concomitantly. The appropriate source for the information, as well as the type and amount of information required, depends on the type of contract and the content of the contract. In order to consider selective contracts with doctors or groups, data and evaluations from random samples of relevant size, which also allow regionally valid considerations and extrapolations, are required. Evaluations from billing data are not sufficient here because they do not adequately reflect medical behavior.
23.09.2012
The IT Implementation of Selective Contracts The goal of selective contracts pursuant to Section 73b, c of the Social Code (SGB V) is to improve the quality of outpatient care while simultaneously exploiting potential for cost-effectiveness. By creating the option to conclude selective contracts, the legislature aimed to enable direct negotiations between health insurance funds and physician groups to agree on specific quality goals in care and cost-effectiveness. To achieve this, […]
23.09.2012
With the entry into force of Section 73b SGB V as amended by GKV-Org WG, all statutory health insurance companies were obliged to offer their insured persons special family doctor care (family doctor-centered care) by June 30, 2009. The consequence of these contracts is an adjustment of the total remuneration. The effects of an adjustment of the total remuneration on the individual doctor and practice were and are the subject of heated discussions at various levels.
01.02.2010
In the German healthcare system, too, the inflexible and almost anti-performance remuneration systems in the outpatient and inpatient sectors are repeatedly criticized. In particular, thanks to the Expert Council for the Assessment of Developments in the Health Care System in 2007 and the activities of the National Association of Statutory Health Insurance Physicians, an increasing dynamic towards P4P can now also be observed in Germany. In this context, the regulations on selective contracts play a special role. It is actually only logical to reward those who perform above average and/or those who have improved significantly. Experience with concepts mainly comes from the USA and Great Britain. The first approach presented here as an example was developed by the Integrated Health Association (IHA), an association of various healthcare players, in California. Another innovative approach in the European discussion is the reorganization of general practitioner remuneration in Great Britain. However, the situation is fundamentally different than in the American models, as this involves the distribution of additional money based on performance. Although there are still no valid evaluation results, the Advisory Council (SVR) found positive results in 21 of 28 studies. Accordingly, P4P is one of the most important developments in the international discussion in recent years.
01.12.2009
Since 2009, the health insurance companies that compete with each other for care have had to conclude common and uniform collective agreements for the remuneration of medical services on the basis of very narrow centralized guidelines. One way out of bringing innovation into care is to conclude individual health insurance selective contracts. At the same time, since 2009, all health insurance companies have been obliged to offer their insured persons particularly qualified family doctor-centered care on a voluntary basis. In order to prevent double financing of services, these selective contracts require an adjustment of the jointly and uniformly determined collective remuneration. The article shows which procedures are useful here in order to achieve a fair coexistence of collective system and selective contracts with the aim of innovation capability for the supply structures.