Abstracts by keywords: Integrated health care
The realignment of care structures to optimize health care across the various service sectors is one of the most important health policy challenges for several decades. Even though medical care in Germany is still characterized by good accessibility and a high level of quality, the frequently discussed challenges in care - keywords include demographic development, multimorbidity, a shortage of doctors and skyrocketing costs - are increasingly threatening to ensure this level of care. Assuming that supply needs can no longer be adequately met in terms of quality and logistics via traditional forms of organization, the structures as a whole must be put to the test and, if necessary, redesigned. In the last ten years in particular, lawmakers have increasingly implemented a variety of laws and reforms to strengthen intersectoral cooperation. With the GKV Health Reform Act in 2000, integrated care was incorporated into German legislation for the first time and reformulated with the GKV Modernization Act of 2004. This formed the basis for selective contractual relationships between health insurance companies and service providers and was instrumental in the increasing importance of cross-sector forms of care. The most recent health care reform as part of the Care Structure Act (VstG), which came into force in January 2012, does not create a breakthrough for cross-sector care models, but it does set certain prerequisites for better interlinking of the service sectors. With the change in § 87 b SGB V, the importance of doctor networks in particular is experiencing a new dynamic. Doctors are significantly more motivated to participate in cooperative models through the possibility of separate remuneration regulations and fee volumes for networked practices.
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
Integrated supply models are legally and politically supported in Germany. The aim of such models is to contribute to optimizing high-quality and economical patient care by promoting collaboration between service providers within and between the outpatient, acute inpatient, rehabilitation and nursing sectors. Due to the ongoing cost pressure in the German healthcare system, redundancies and frictional losses between the players should be reduced and the burden on social security funds should be relieved. An essential feature of integrated care models is that providers, consumers and cost bearers conclude an individual contract on the basis of selective contracts and on a voluntary basis (see §§140a and b SGB V). In doing so, the legislature has moved away from the collective bargaining system in order to promote greater competition and efficiency in the healthcare system. This opens up the possibility for health insurance companies in particular to select service providers according to their own criteria, negotiate remuneration systems and thus standardize service financing and service delivery under one roof (cf. Amelung 2009, p.6f.). The result is a change in the roles in the traditional triangular structure of insurance company - service provider - patient. The benefit for service providers is to distinguish themselves and professionalize themselves in the competition by offering special treatment programs. Proof of good quality and reputation thus becomes the focus of interest for service providers. Patients benefit from coordinated treatment and quality through, for example, integrated treatment paths (Waehlert/Wagner/Czap 2010) as well as possible bonuses/discounts or other improved conditions from the payers through participation in integrated care models. In return, the patients usually give up their free choice of doctor and undertake to recognize the performance control in the specified contract.