Abstracts by keywords: statutory health insurance
Adipositas und ihre Folgeerkrankungen zählen weltweit zu den bedeutendsten Herausforderungen für die öffentliche Gesundheit. Mit der steigenden Verbreitung von Adipositas nehmen auch kardiometabolische Erkrankungen (z. B. Typ-2-Diabetes mellitus, arterielle Hypertonie, koronare Herzkrankheit und Herzinsuffizienz), bestimmte Tumorerkrankungen und Muskel-Skelett-Erkrankungen zu. Bei Erwachsenen in Deutschland zählt ein höherer Body-Mass-Index (BMI) zu den größten Risikofaktoren im Hinblick auf die […]
05.10.2026
Since forms of reimbursed medical treatment have become known, there have also been fears that healthcare professionals will recommend care options to their patients that are not or not yet necessary. This fear becomes explosive in terms of health policy with regard to statutory health insurance, in which the costs and consequential costs for treatments that are not reported or not yet reported are financed in solidarity by all of the insured (Breyer/Zweifel/Kifmann, 2013; Breyer/Buchholz, 2021). As early as 2000/2001, the Advisory Council stated in its report that care with non-indicated services or with services without a sufficiently secured net benefit is tantamount to "medical oversupply". On the other hand, services with only a minor benefit that no longer justifies the costs or are provided in an inefficient (i.e. uneconomical) form are classified as “economic oversupply” (Sachverständigenrat 2000/2001). This form of incorrect care is also associated with incorrectly set incentives, which manifest themselves in low-threshold access conditions and can thus lead to the use of inappropriate levels of care (John/Stillfried 2021).
17.05.2022
On January 28, 2020, the Scientific Commission for a Modern Remuneration System (KOMV) handed over its “recommendations for a modern remuneration system” to the Federal Minister of Health (KOMV 2019).1 The coalition agreement for the 19th legislative period instructed it to “by the end of 2019 "Taking into account all related medical, legal and economic questions" to develop proposals for "a modern compensation system" that "represents the care needs of the population and the status of medical progress" (Coalition Agreement 2018, 4589-4594). The passage in the coalition agreement setting up the Scientific Commission was rounded off with a remarkable outlook: “Whether these suggestions will be implemented will be decided afterwards” (Coalition Agreement 2018, 4593f.). This cute, because somehow self-evident statement was an expression of the coalition's disunity: While Karl Lauterbach, the SPD's chief negotiator for the health policy part of the coalition agreement, saw the merger of the two remuneration systems for medical services as a building block of a unified health insurance system, the CDU was likely to do so /CSU have connected the declaration of intent "for the drawer" with this sentence (Jacobs 2020, 14).
07.08.2021
In medical practices, patients are increasingly being offered individual health services (IGeL). These services are to be paid for by the insured persons themselves, as they are outside the range of services provided by statutory health insurance. It is important for patients to be well informed about the benefits and possible harm of these medical measures before using an IGeL. It is also important that independent information on IGeL services is available. For this reason, the medical service of the National Association of Statutory Health Insurance Funds has launched the "IGeL Monitor" evaluation portal, in which evaluations of frequently offered IGeL services and further information on the IGeL services are published. In the article, the development of the IGeL market is presented, the information platform IGeL-Monitor and its evaluation results are presented and, based on this, some conclusions are drawn for dealing with IGeL services. Above all, the responsibility of the medical profession when selling IGeL services is emphasized and recommendations are given for patients on how to deal with IGeL offers.
31.03.2015
Intravitreal surgical medication administration (IVOM) has been a standard service for surgical ophthalmologists (ophthalmic surgeons) since 2005. “Macugen” was approved by the European regulatory authority EMA on January 31, 20061. Ranibizumab (“Lucentis”) was approved on February 22, 20072. With the MARINA and ANCHOR approval studies for “Lucentis”, the company Genentech was able to demonstrate that a monthly administration of 0.5 mg ranibizumab leads to visual acuity stabilization in around 95% of patients and that a clinically significant improvement in visual acuity can be achieved in around 34% of patients3,4. This medical breakthrough in the treatment of wet AMD prompted a large number of ophthalmologists in Baden-Württemberg, among others, to offer the treatment of wet AMD with bevacizumab in 2005 in order to help all those patients who would otherwise at least have to wait until the EMA approval and the availability of “Lucentis” in Germany would have suffered irreversible loss of vision. Bevacizumab and ranibizumab have an identical mechanism of action5. This means that a significant proportion of those insured by AOK Baden-Württemberg with wet AMD were already on bevacizumab therapy at the time “Lucentis” was launched on the market in February 2007.
31.03.2015
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.
24.01.2013
Providing Multiple Sclerosis Patients with Ready-to-Use Cannabis Medicinal Products. Spasticity is one of the most significant symptoms of multiple sclerosis (MS), which is associated with significant limitations in daily life. Cannabis has been discussed for some time as a possible option for inadequately treatable spasticity, but for a long time, there were no approved preparations in Germany. This changed in the middle of last year, when […]
25.09.2012
Many scientific innovations are developed in the field of basic research and then, based on the results of in-vitro research, are so solidly processed through small animal experiments that the path to applying these processes to humans is cleared. Further clinical research deals with measuring the effect of the therapeutic procedure and the side effects and at the same time lays the foundation for the approval procedures of the relevant authorities in North America and Europe. In order to be able to measure the effectiveness of therapeutic procedures, special patient groups are often put together in order to measure the effect of the new procedure/medication on a placebo procedure or on other, often older, medications or medical procedures/procedures in prospective randomized studies. A fundamental bias in these studies is often a strictly selected patient population that only slightly corresponds to the overall “real world” population addressed under field conditions.
07.02.2011
The instrument of drug discount contracts was implemented in the statutory health insurance (GKV) system in order to curb drug spending in the outpatient sector. The GKV Competition Strengthening Act (GKV-WSG), which came into force on April 1, 2007, paved the way for health insurance companies to be able to conclude discount agreements with pharmaceutical manufacturers more effectively than before. Since then, pharmacists have had to give preference to discounted medications. Ideally, both manufacturers and health insurance companies can benefit from such discount agreements.
01.06.2010
The aim of the present analysis is to compare treatment costs between insulin-glargine and NPH-insulin-based therapies in patients with diabetes mellitus. Using a representative sample of health insurance data, simultaneous co-medication in the indication groups bolus insulin, oral antidiabetics, test strips and lancets/needles over three calendar years was determined for a total of six payers. During the analysis period (2006 - 2008), the aggregated absolute annual treatment costs per diabetes patient for insulin glargine-based therapies tended to be slightly below the costs of the respective NPH comparison groups. The analysis of the individual costs shows that the higher procurement costs for insulin glargine are overcompensated by savings in bolus insulin and test strip consumption. The present database analysis confirms the results of previously published health care research studies, according to which, from the perspective of statutory health insurance (GKV), there is a cost-neutrality between insulin glargine and NPH insulin-based treatment regimens under real care conditions.