The German Health Care System and the Federal Joint Committee (G-BA) Dr. Tilo Mandry – Health – Made in Germany – Santiago de Chile 19.11.2018

Basic principles of the German health care system Germany has about 82 million inhabitants 72 million (50 million members) are covered by statutory health insurance (remaining are privately insured) currently approx. 190 (+50) insurance companies 7 types of sickness funds blue-collar workers = regional health insurance funds (AOK), or substitute funds (EK Arb) guild funds (IKK) or company-based sickness funds (BKK) white-collar workers = substitute health insurance funds (EK Ang) farmers‘, miners‘, sailors‘ funds

Basic principles of the German health care system II today‘s characteristics: share of premiums between employee and employer self-administration / self-government MoH sets general rules, details regulated by self- governing bodies free choice of sickness-funds and providers comprehensive benefit catalogue opting out of statutory insurance above annual income of 49,000€ for three years in a row (one year in future?) contribution rate: 0.5% for dentures to be covered by employees alone

Basic principles of the German health care system III today‘s characteristics (cont.): working solidarity principle, i.e. no surcharge for age or risk low salary = low payment contributions for unemployed & welfare recipients paid by public funds highly developed infrastructure, no waiting lists in hospitals problems: aging society, innovations, costs (> especially for hospitals and pharmaceuticals) contribution payment dependent of salary up to an annual ceiling (currently 46,800€, i.e. 3,900 per month)

The Federal Joint Committee (G-BA) G-BA is the main decision-making body in the German health care system, authorised by law to issue legally binding directives - but not a subordinate authority Legal Basis: Social Code (Book V) established in the year 2004, but predecessor committees dating back to the 1920s, represents physicians, hospitals, sickness funds and patients.

What does the G-BA do? The G-BA issues directives and guidelines. It thus determines the benefit package for: Ambulatory and hospital care Dental care Psychotherapy Diagnostic and therapeutic procedures and interventions Quality assurance Disease management programmes for chronic diseases Pharmaceuticals, Vaccines and Medical Devices …

What does the G-BA NOT do? Contracts between single payers (e.g. sickness funds) and providers or manufacturers Regulation of premiums Risk adjustment among the sickness funds Payment of doctors Determination of the amount paid for procedures, interventions or pharmaceuticals DRGs

“Who” is the G-BA? Health care providers Federal association of office-based doctors Federal hospitals’ associaton Health care payers Federal association of sickness funds Representatives of sickness funds Three Impartial Members Patients’ representatives Non-voting members

Co-operation with the Institute for Quality and Efficiency in the Healthcare System (IQWiG)

Discussion G-BA decisions are under the legal supervision of the Ministry of Health Procedure and decision about benefit assessments take a (too) long time, in some cases coverage of innovations are delayed Discrepant regulation for coverage decisions for outpatient and hospital sector

©Chris Schmidt - istockphoto Thank you! tilo.mandry@gtai.com www.gtai.com www.health-made-in-germany.com