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[Options for a future risc structure compensation in Germany].

W Greiner1

  • 1Fakultät für Gesundheitswissenschaften, School of Public Health - WHO Collaborating Center, AG 5 - Gesundheitsökonomie und Gesundheitsmanagement, Universität Bielefeld. wolfgang.greiner@uni-bielefeld.de

Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany))
|July 27, 2006
PubMed
Summary

The German statutory health insurance risk adjustment system needs refinement to better orient towards morbidity. A revised system could improve solidarity and incentivize cost management within sickness funds.

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Area of Science:

  • Health Economics
  • Social Insurance Policy
  • Public Health Systems

Context:

  • The German statutory health insurance system employs a risk structure compensation scheme to uphold solidarity among sickness funds.
  • Current criticism focuses on the system's lack of morbidity orientation, potentially distorting contribution rates based on risk rather than efficiency.
  • This study evaluates the validity of these criticisms and explores alternative adjustment mechanisms.

Purpose:

  • To analyze the current risk adjustment variables and methods in German statutory health insurance.
  • To compare the existing system with a proposed morbidity-oriented alternative.
  • To assess the potential impact of a revised system on cost management and solidarity.

Summary:

  • The current risk adjustment uses variables like age, sex, income, and participation in Disease-Management-Programs (DMPs).

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  • A morbidity-oriented adjustment is feasible, as standardized costs form the basis for compensation, not actual expenditures.
  • Incentives for cost management can be maintained by partially adjusting morbidity-determined costs.

    • Impact:

    • A refined risk adjustment, incorporating morbidity and outpatient care, could enhance efficiency and solidarity.
    • Revising the system may mitigate incentive problems arising from continuous adjustments.
    • Implementing a new honorarium system could provide a better data foundation for future risk adjustment improvements.