[Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance]

Gesundheitswesen. 2009 Jan;71(1):19-23. doi: 10.1055/s-0028-1102930. Epub 2009 Jan 27.
[Article in German]

Abstract

This paper gives a systematic overview of resource use that is relevant within the German health-care system from the perspective of the statutory health insurance and how these resource uses should be priced in economic analyses. This includes all relevant cost domains from ambulatory and inpatient care as well as a detailed description of relevant data resulting from drug usage. For prescriptions the legal framework (e.g., reference pricing) is applied to list all relevant co-payments or discounts (e.g., for pharmaceutical companies) which have to be considered in patented as well as off-patent drugs. The same method is applied for ambulatory services [taking the universal remuneration scheme (EBM) into account] as well as for inpatient stays (discussing certain characteristics of the German DRG system). As a result, for the first time, a pragmatic as well as a practical approach is presented to value resource usage within the German health care system in future studies from the perspective of the statutory health insurance or, in other words, the sickness funds.

MeSH terms

  • Costs and Cost Analysis
  • Germany
  • Models, Economic*
  • National Health Programs / economics*
  • National Health Programs / statistics & numerical data*
  • Resource Allocation / economics*
  • Resource Allocation / statistics & numerical data*
  • Utilization Review*