Statutory health insurance – law to strengthen the medical treatment

In retrospect – real strengthening or more window-dressing?

On 23.07.2015, the law to strengthen the medical treatment in Germany came into force with the aim of making health care future-proof.

What is the situation today, two years after the entry into force? We will provide a brief overview of the milestones achieved, the hurdles and an outlook on the future.

Good medical care should not be a question of the place of residence in the future either. Particularly in rural areas, increased efforts are needed to maintain a good supply. … At the same time, it is about to develop the medical care wisely. The fund for innovation is intended to provide targeted support for projects that are taking new forms of medical care, „said Hermann Gröhe, Minister of Health.

The regulations in detail

On the pages of the Federal Ministry of Health, 16 regulations from the law to strengthen medical care are listed in detail.

These include, among other things, stronger incentives for the medical establishment out of the fund for structure. Likewise, municipalities are given the opportunity to play an active role in the development of medical care centers (MVZ).

Medical reimbursement is to be strengthened by the timely adjustment of the accounting system (EBM).

Various points were agreed for the benefit of the patients, such as, for example, more options for medical rehabilitation, claim to a second opinion of a doctor in certain cases, entitlement to sickness benefit from the date of the medical examination.

The Association of Statutory Health Insurance Physicians have set up centers, which are intended to provide patients with an appointment with a specialist doctor’s within 4 weeks.

The establishment of the fund for innovation to promote innovation in health care and health care research, as well as the new evaluation procedure for medical devices of the high risk class, have led to the most questions, and possibly also expectations, especially on the side of the medical device manufacturers.

Where we are today?

The service centers were established at the beginning of 2016 by The Association of Statutory Health Insurance Physicians. The current feedback from patients on this subject is manifold and certainly to contemplate regional.

Although the National Association of Statutory Health Insurance Physicians positioned itself rather critically to the establishment of medical care centers (MVZs) by the municipalities, the „Büsum model“ was very well received by other municipalities, who took this as an example to provide a possible medical under-supply in their Region. However, a clearly recognizable implementation has not yet taken place, so that the problem of medical under-supply is still present in many rural regions.

Many expectations were placed to the innovation fund, set up by the Joint Federal Committee (G-BA) at 300 million euros annually, initially for the years 2016 to 2019. The funds for this fund are borne by the statutory health insurance funds and the health fund. The Bundesversicherungsamt has the task of administering the funds of the innovation fund. 225 million euros are available annually for the promotion of new forms of health care, 75 million euros for health care research.

Within the scope of the new forms of health care, projects are being promoted which are aimed at improving cross-sectoral care and have the potential to be permanently included in the regular care. The use and research of product innovations are not the focus of eligible projects.

In the field of health care research, 3 types of research projects are supported:

  • Research projects aimed at a gain in knowledge to improve the existing care in statutory health insurance
  • Evaluation projects on existing selective contracts (Sections 73C and 140a SGB V)
  • Research projects for the further development and, in particular, the evaluation of guidelines of the G-BA

These funds are to be used in particular by universities and research institutes.

In the list of currently running and subsidized projects on the Internet pages of the G-BA, it can be seen that the participation of the manufacturers is scantily low, which underlines the lack of focus on the use and research of product innovations.

But are not already established, innovative medical devices contributing to an improvement in cross-sectoral medical care? And is it often not just a question of taking over in standard care?

A clear structured project in cooperation with the insurance companies could certainly contribute nationwide to establish an innovation in the standard care. However, this was not yet applied for in 2016 or not approved. It remains to be seen whether such projects can be found in the list in the coming years.

In conclusion, the new assessment procedure for medical devices of the high risk class according to § 137h SGB V led to many questions and discussions on the part of the manufacturers as well as the users.

The new assessment procedure is not only extremely complex in terms of content and time; The G-BA assumes a process duration of 1 to 2 years in the best conditions. The test procedures (§ 137 SGB V et seq.) are also proving to be particularly challenging and it remains to be seen what consequences this will have on the introduction of innovative medical products.

The subject of §137 SGB V and its effects on the medical device industry is quite complex. We will debate this issue separately and keep you up to date.

Conclusion

The expectations of the statutory health insurance – law to strengthen the medical treatment were great on the part of the patients, the medical device industry as well as the insurance companies. Some points could be implemented in a timely manner. Others, such as the establishment of discharge management, led to disagreements and thus to delays in implementation.

After 2 years, it can be said today that the first step has been taken, but new hurdles have also surfaced in the implementation. The goal in the next step must be to take the hurdles together in order to achieve an innovative and, in particular, a stable, comprehensive medical care in all regions of Germany.

The possibilities offered by the innovation fund as well as a clear, structured and goal-oriented approach within the scope of the new assessment procedures contribute to this.

We will be glad to answer your questions about this exciting and challenging topic.


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