Defining benefit catalogues and entitlements to health care in Germany: Decision makers, decision criteria and taxonomy of catalogues

This paper studies the politico-economic reasons for the refusal of a proposed compulsory flood insurance scheme in Germany. It provides the rationale for such scheme and outlines the basic features of a market-orientated design. The main reasons for the political down-turn of this proposal were the (mis)perceived costs of a state guarantee, legal objections against a compulsory insurance, distributional conflicts between the federal government and the German states (Länder) on the implied administrative costs and the well-known samariter dilemma of ad-hoc disaster relief. The focus on pure market solutions proved to be an ineffective strategy for policy advice in this field. -- Während die Rahmenbedingungen für das deutsche Gesundheitssystem vom Gesetzgeber vorgegeben werden, obliegt die Bestimmung einzelner Leistungen bzw. Leistungsinhalte den Entscheidungsträgern der Selbstverwaltung. Dabei variiert die Genauigkeit der Leistungsdefinition zwischen verschiedenen Sektoren und Ausgabenträgern. Während die Leistungen einiger Ausgabenträger nur implizit definiert sind, ist der Leistungsumfang anderer Ausgabenträger bereits explizit als Leistungskatalog formuliert. Dabei orientiert sich die Mehrheit der Ausgabenträger an dem Leistungsumfang der gesetzlichen Krankenversicherung (GKV) und überträgt diesen in den eigenen Bereich. Im Rahmen der GKV, die ca. 88% der Bevölkerung versichert und 56,9% der Gesundheitsausgaben trägt, bestimmen verschiedene Kataloge zusammen mit den Richtlinien des Gemeinsamen Bundesausschusses den Leistungsumfang. Die Leistungen, der Aufbau und der Inhalt der Leistungskataloge, die an der Definition der Kataloge beteiligten Akteure, sowie die Entscheidungskriterien für die Aufnahme neuer Leistungen in die Leistungskataloge der Sozialversicherungen werden in diesem Zusammenhang ausführlich dargestellt und analysiert.

Bürgerversicherung: Die Wirkung von Kopfprämien auf den Arbeitsmarkt

In der öffentlichen Diskussion um die Einführung einer Bürgerversicherung zur Reform der Finanzierung der Gesetzlichen Krankenversicherung werden häufiger Modelle mit Kopfpauschalen oder Kopfprämien diskutiert. Dabei sind verschiedene Herangehensweisen bei der Ermittlung der Höhe der Prämien und der Ausgestaltung der Versicherungspflicht möglich. Diese Arbeit soll mit Hilfe der Mikroökonomie und im Rahmen eines einfachen Queru - Modells die Auswirkungen eines solchen Schrittes auf den Arbeitsmarkt aufzeigen. Des weiteren werden mögliche Konzepte für die Behandlung der bisher mitversicherten Kinder, sowie eine Umgestaltung des Familienlastenausgleichs thematisiert. -- Capitation fees are considered to be an option for a change in funding principles for statutory health care insurance. This paper discusses several models of capitation fees either to be introduced for a part of the population or for all citizens. It analyses the impact of a change in financing health care on the labour market. Therefore microeconomic theory and a Queru model is applied. It also considers the issue of presently co-insured dependents.Kopfpauschale,Bürgerversicherung,Arbeitsmarkt,capitation fee,financing health care,labour market

Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany: Methodologies and criteria

The issue of defining health benefit catalogues has recently gained new importance in Germany as a result of the creation of the new Institute for Quality and Efficiency. The Institute was designed to support the Federal Joint Committee conducting effectiveness studies for benefit coverage decisions. The Committee and the contractual partners (sickness funds and providers) define the benefit catalogues for the Statutory Health Insurance in the framework of Social Code Book V, Germany’s most relevant health care scheme. Unlike other countries, the German federal government limits its regulatory role to defining procedures that determine the scope of Statutory Health Insurance services. The explicitness of the benefit catalogues varies greatly between different sectors. While benefits in outpatient care are rather explicitly defined, benefit definitions for inpatient care are vague. It is argued that the establishment of the new Institute and the development of the DRG system are initial steps towards a more effective and explicit benefit catalogue

An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals

Objective Development of an aggregate quality index to evaluate hospital performance in cardiovascular events treatment. Methods We applied a two-stage regression approach using an accelerated failure time model based on variance weights to estimate hospital quality over four cardiovascular interventions: elective coronary bypass graft, elective cardiac resynchronization therapy, and emergency treatment for acute myocardial infarction. Mortality and readmissions were used as outcomes. For the estimation we used data from a statutory health insurer in Germany from 2005 to 2016. Results The precision-based weights calculated in the first stage were higher for mortality than for readmissions. In general, teaching hospitals performed better in our ranking of hospital quality compared to non-teaching hospitals, as did private not-for-profit hospitals compared to hospitals with public or private for-profit ownership. Discussion The proposed approach is a new method to aggregate single hospital quality outcomes using objective, precision-based weights. Likelihood-based accelerated failure time models make use of existing data more efficiently compared to widely used models relying on dichotomized data. The main advantage of the variance-based weights approach is that the extent to which an indicator contributes to the aggregate index depends on the amount of its variance

Patient expectations do matter - Experimental evidence on antibiotic prescribing decisions among hospital-based physicians

Background: The global public health crisis of antibiotic resistance is being driven in part by over prescription of antibiotics. We aimed to assess the relative weight of patient expectations, clinical uncertainty, and past behaviour on hospital-based physicians' antibiotic prescribing decisions. Methods: A discrete choice experiment was administered among hospital-based physicians in Tuscany, Italy. Respondents were asked to choose in which of two clinical scenarios they would be more likely to prescribe antibiotics, with the two cases differing in levels of clinical uncertainty, patient expectations, and the physician's past behaviour. We fitted a conditional logistic regression. Results: Respondents included 1,436 hospital-based physicians. Results show that the odds of prescribing antibiotics decrease when a patient requests it (OR=0.80, 95%CI [0.72,0.89]) and increase when the physician has prescribed antibiotics to a patient under similar circumstances previously (OR=1.15, 95%CI [1.03,1.27]). We found no significant effect of clinical uncertainty on the odds of prescribing antibiotics (OR=0.96, 95%CI [0.87, 1.07]). Conclusions: We show that patient expectation has a significant negative association with antibiotic prescribing among hospital-based physicians. Our findings speak to the importance of cultural context in shaping the physician's disposition when confronted with patient expectations. We suggest shared decision-making to improve prudent prescribing without compromising on patient satisfaction

Cooperation Improvement in an Integrated Healthcare Network: A Social Network Analysis

Background: Cooperation is a core feature of integrated healthcare systems and an important link in their value-creating mechanism. The premise is that providers who cooperate can promote more efficient use of health services while improving health outcomes. We studied the performance of an integrated healthcare system in improving regional cooperation. Methods: Using claims data and social network analysis, we constructed the professional network from 2004 to 2017. Cooperation was studied by analyzing the evolution of network properties at network and physician practice (node) level. The impact of the integrated system was studied with a dynamic panel model that compared practices that participated in the integrated system versus nonparticipants. Results: The regional network evolved favourably towards cooperation. Network density increased 1.4% on average per year, while mean distance decreased 0.78%. At the same time, practices participating in the integrated system became more cooperative compared to other practices in the region: Degree (1.64e-03, p = 0.07), eigenvector (3.27e-03, p = 0.06) and betweenness (4.56e-03, p < 0.001) centrality increased more for participating practices. Discussion: Findings can be explained by the holistic approach to patients’ care needs and coordination efforts of integrated healthcare. The paper provides a valuable design for performance assessment of professional cooperation. Highlights • Using claims data and social network analysis, we identify a regional cooperation network and conduct a panel analysis to measure the impact of an integrated care initiative on enhancing professional cooperation. • Physician practices participating in the integrated system became more cooperative and improved their influence in the regional network more than non-participating practices. • Integrated healthcare systems effectively incentivize cooperation through a holistic approach to patient care needs and coordination efforts

Jumping the Queue:Willingness to Pay for Faster Access to COVID-19 Vaccines in Seven European Countries

Introduction: Given the initial shortage of vaccines to protect against coronavirus disease 2019 (COVID-19), many countries set up priority lists, implying that large parts of the population had to wait. We therefore elicited the willingness to pay (WTP) for access to two hypothetical COVID-19 vaccines. Methods: Respondents were asked how much they would be willing to pay to get an immediate COVID-19 vaccination rather than waiting for one through the public system. We report data collected in January/February 2021 from the European COVID Survey (ECOS) comprising representative samples of the population in Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK (N = 7068). Results: In total, 73% (68.5%) of respondents were willing to pay for immediate access to a 100% (60%) effective vaccine, ranging from 66.4% (59.4%) in the Netherlands to 83.3% (81.1%) in Portugal. We found a mean WTP of 54.36 euros (median 37 euros) for immediate access to the 100% effective COVID-19 vaccine and 43.83 euros (median 31 euros) for the 60% effective vaccine. The vaccines’ effectiveness, respondents’ age, country of residence, income, health state and well-being were significant determinants of WTP. Willingness to be vaccinated (WTV) was also strongly associated with WTP, with lower WTV being associated with lower WTP. A higher perceived risk of infection, higher health risk, more trust in the safety of vaccines, and higher expected waiting time for the free vaccination were all associated with a higher WTP. Conclusion: We find that most respondents would have been willing to pay for faster access to COVID vaccines (jumping the queue), suggesting welfare gains from quicker access to these vaccines. This is an important result in light of potential future outbreaks and vaccines.</p