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2019 | OriginalPaper | Chapter

Options for Realising and Financing Innovation in the German Healthcare System

Authors : Bernd Baron von Maydell, Boris Baron von Maydell

Published in: Personalized Medicine in Healthcare Systems

Publisher: Springer International Publishing

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Abstract

Personalised healthcare is experiencing the same difficulties as other innovations when it is introduced to the different health systems of countries. However, the high treatment costs and the complicated evaluation of the added value compared to existing methods and procedures represent particularly great challenges for personalised medicine providers and healthcare systems. In the German health care system, a large number of mechanisms have been implemented, on the one hand, to enable the fundamental introduction of innovations and, on the other hand, to permit only those innovations for standard care that bring additional benefits to the respective patients.
The first part of this article discusses the question of the prerequisites and framework conditions that help an innovation to be included in the benefits catalogue of statutory health insurance in Germany. Once this question has been successfully addressed, providers and cost bearers are faced with the difficult task of financially evaluating the new service. This is the subject of the second part.
Ultimately, a new method can only improve care if it is recognised and financed by the health systems. Against the background of increasing costs for new treatment methods, it is the task of the processes described to prevent scaling in new medical procedures.

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Footnotes
1
Self-regulation is the overarching organisational principle for Statutory Health Insurance in Germany. It means that providers in the healthcare sector, insured persons and employers handle organisation themselves to direct and help shape the healthcare system (Verband der Ersatzkassen e.V. 2018).
 
2
The Federal Joint Committee (G-BA, Gemeinsamer Bundesausschuss) is the highest-level decision-making committee run by German doctors, dentists, psychotherapists, hospitals and health insurance funds working jointly. By issuing directives, they set the catalogue of benefits offered by the Statutory Health Insurance funds for more than 70 million insured persons and, in doing so, determine what benefits are eligible for payouts under the medical care offered by the Statutory Health Insurance system. Furthermore, the G-BA decides on actions for quality assurance in hospital and non-hospital areas of the healthcare sector (Federal Joint Commitee 2018b).
 
3
The Valuation Committee is a committee of doctors and health funds acting jointly for organisational purposes. For this reason, it is also known as the Doctors’ Valuation Committee. It is made up of six members, with three appointed by the National Association of Statutory Health Insurance Physicians and three by the National Confederation of Regional Statutory Health Insurance Associations. The Institute for the Valuation Committee manages the Valuation Committee (Institute for the Valuation Committee 2018).
 
4
The National Association of Statutory Health Insurance Physicians is the umbrella association for the 17 regional Associations of Statutory Health Insurance Physicians. It organises extensive, locally-provided Out-of-Hospital healthcare and represents at national level the interests of doctors and psychotherapists working in the Statutory Health Insurance system (National Association of Statutory Health Insurance Physicians 2018).
 
5
The National Confederation of Regional Statutory Health Insurance Associations (GKV-Spitzenverband) is the main representative of Statutory Health and Nursing Insurance funds in Germany and at European and international levels. It is responsible for the overall conditions necessary for healthy competition in quality and efficiency in healthcare and nursing care (National Confederation of Regional Statutory Health Insurance Associations 2018).
 
Literature
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Metadata
Title
Options for Realising and Financing Innovation in the German Healthcare System
Authors
Bernd Baron von Maydell
Boris Baron von Maydell
Copyright Year
2019
Publisher
Springer International Publishing
DOI
https://doi.org/10.1007/978-3-030-16465-2_1