Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years. A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in turn led to the right for insured individuals to freely choose their health-care providers. In 1993, the freedom to choose one's sickness fund was formally introduced, and reforms that encourage competition and a strengthened market orientation have gradually gained importance in the past 25 years; these reforms were designed and implemented to protect the principles of solidarity and self-governance. In 2004, self-governance was strengthened through the establishment of the Federal Joint Committee, a major payer-provider structure given the task of defining uniform rules for access to and distribution of health care, benefits coverage, coordination of care across sectors, quality, and efficiency. Under the oversight of the Federal Joint Committee, payer and provider associations have ensured good access to high-quality health care without substantial shortages or waiting times. Self-governance has, however, led to an oversupply of pharmaceutical products, an excess in the number of inpatient cases and hospital stays, and problems with delivering continuity of care across sectoral boundaries. The German health insurance system is not as cost-effective as in some of Germany's neighbouring countries, which, given present expenditure levels, indicates a need to improve efficiency and value for patients.
Gesundheitssystemforschung an der Medizinischen Hochschule Hannover Franz Knieps ist Partner bei Wiese Consult und leitete von 2002 bis Ende 2009 die Abteilung Gesundheitsversorgung, Krankenversicherung, Pflegesicherung im Bundesministerium für Gesundheit Dr. Sascha Wolf ist Geschäftsführer des Bundesverbandes Managed Care e.V. Das Gesundheitswesen in Deutschland kennt ein gleichzeitiges Nebeneinander von Über-, Unter-und Fehlversorgung -je nach Region, Stadtteil, Bevölkerungs gruppe, Versorgungsbereich oder Indikation. An dieser Feststellung hat sich auch eine Dekade nach der grundlegenden Bestandsaufnahme durch den Sachverständigenrat für die Begutachtung der Entwicklung im Gesundheitswesen wenig geändert. Der folgende Beitrag gibt einen Überblick über den gegenwärtigen Zustand und über zu erwartende Entwicklungen. Er beschreibt die rechtlichen und ökonomischen Rahmenbedingungen für die Sicherstellung der Versorgung und die Planung von Kapazitäten und Versorgungsaufträgen. Er zeigt Bespiele auf, mit welchen Versorgungskonzepten und Steuerungsansätzen Überversorgung abgebaut und Unterversorgung behoben oder zumindest gelindert werden könnten. Dabei kommt der Politik in Bund, Ländern und Kommunen eine Schlüsselrolle zu, auch wenn es keinen alleinigen Lösungsansatz gibt, der überall Erfolg verspricht. Nur ein Zusammenwirken etablierter Akteure mit neuen Playern -wie zum Beispiel die Telekommunikationsindustrie und anderen Dienstleistern -wird den sehr unterschiedlichen Entwicklungen vor Ort gerecht werden können. Die medizinische Versorgung in Deutschland zeichnet sich durch eine nahezu flächendeckend gute Erreichbarkeit sowie ein hohes Qualitätsniveau aus, wenn auch das deutsche Gesundheitssystem in internationalen Rankings kontinuierlich "durchgereicht" wird (z. B. Health Consumer Powerhouse 2010 Rang 6, 2012 Rang 14). Die Leistungserbringung erfolgt in voneinander weit-gehend abgeschotteten Sektoren, wobei der ambulante Bereich durch eine im internationalen Vergleich hohe Dichte an Hausärzten und eine historisch gewachsene, umfassende Facharztversorgung charakterisiert ist. In der Vergangenheit hat dies dazu geführt, dass die Diskussion um die Weiterentwicklung der ambulanten Versorgung von den Schlagworten "doppelte Facharztschi-
The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germany's statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germany's SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germany's SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal government's innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.