Abstracts by keywords: Risk Adjustment
As of January 1, 2009, the risk structure equalization (RSA) in statutory health insurance was further developed into a morbidity-oriented RSA for 80 serious or cost-intensive chronic diseases (Göpffarth 2009). Since 2003, however, there has been a preliminary stage of morbidity orientation in the form of the coupling of structured treatment programs (also disease management programs - DMP) to the RSA (Busse 2004, Stock et al. 2006). The background was a discussion about the control effect of the (old) risk structure compensation. Among other things, it was criticized that health insurance companies have no (financial) incentives to implement structured treatment programs under the given conditions. If they implemented appropriate programs, the argument goes, they would become attractive to chronically ill people, who would then increasingly switch to health insurance. However, since chronic illnesses are not taken into account in the RSA, these switches would result in negative contribution margins and would thus lead to the financial ruin of the health insurance company.
05.10.2012
The German and Swiss healthcare systems differ fundamentally from one another, despite their common social security law. In terms of health care policy, Germany could learn in particular from Switzerland's positive experiences in the area of citizens' insurance, and Switzerland could learn from Germany in particular from those in the area of morbidity-oriented risk structure compensation and the partial participation of statutory health insurers in the continued payment of wages.