1. The German Health Care System and the Federal Joint Committee (G-BA) Norbert Schmacke FJC/ University of Bremen

2. 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

3. 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?)

4. 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 (> esspecially for hospitals and pharmaceuticals)

5. 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.

6. 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  …

7. 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

8. “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

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

10. 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

11. Thank you for your attention! Contact: schmacke@uni-bremen.de