Authors:
Reinhard Schuster
1
;
Thomas Ostermann
2
;
Timo Emcke
3
and
Fabian Schuster
1
;
4
Affiliations:
1
Department of Health Economics, Epidemiology and Medical Informatics, Medical Advisory Board of Statutory Health Insurance in Northern Germany (MD Nord), 23554 Lübeck, Germany
;
2
Department of Research Methodology and Statistics in Psychology, Witten/Herdecke University, 58448 Witten, Germany
;
3
Department of Prescription Analysis, Association of Statutory Health Insurance Physicians, 23812 Bad Segeberg, Germany
;
4
Sigmund-Freud-PrivatUniversity SFU Vienna, Faculty of Law, 1020 Vienna
Keyword(s):
Drug Prescriptions in Outpatient Treatment, Statutory Health Insurance in Germany, Sickness (Health Insurance) SHI Funds in Germany, Morbidity Related Groups (MRG), Risk Structure Compensation between the Health Insurance Companies (RSC), Gini Coefficients, Lorenz Curves.
Abstract:
Benchmarks for pharmaceuticals have been used for over 25 years to limit the cost increase in the second largest cost block in statutory health insurance in Germany with financial punishments for the physicians. The Regional Social Court of Dresden declares such a payback practice to be inadmissible if no age reference is used. In 2016, in most regions of the statutory health insurance associations, the division into status groups members, family members and pensioners has been changed into four age groups. The Supply Strengthening Act has opened up the possibility of drafting regional agreements. In Schleswig-Holstein, Morbidity Related Groups (MRG) were introduced for morbidity-related considerations. A number of other regions are currently using retrospective average cost limitations, which have the same problems as the benchmark restrictions. The aim of this paper is to investigate the influence of the type of health insurance (sickness) fund on the benchmark result with status a
nd with age groups. Different morbidity structures between the health insurance funds are the subject of the risk structure compensation. For doctors, this aspect is not given sufficient consideration with respect to patient-specific morbidity characteristics till now.
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