Abstracts by keywords: services provided through statutory health insurance
The benefits of statutory health insurance include the prevention, early detection and treatment of illnesses as well as aftercare. All services provided at the expense of the GKV are subject to the cost-effectiveness requirement according to §12 SGB V. The population-oriented distribution of morbidity (approximately 20% of the insured persons tie up around 80% of the services) means, conversely, that approximately 80% of the insured persons actually receive no or only very few services claim. A financing model must take this into account (false price signals) as well as the politically responsible design of an effectiveness-based performance framework. This highlights the need to examine which services should be collectively financed. Medical procedures, products and medicines must be evaluated with regard to their effect (ideally the patient-relevant benefit) in order to include them in the GKV's catalog of services or, if necessary, exclude them.