Determining the 'Health Benefit Basket' of the Statutory Health Insurance Scheme in Germany: Methodologies and Criteria

European Journal of Health Economics, Vol. 6, No. 1, pp. 30-36, Dec. 2005

7 Pages Posted: 28 Mar 2010 Last revised: 5 Jul 2010

See all articles by Reinhard Busse

Reinhard Busse

Technische Universität Berlin (TU Berlin)

Tom Stargardt

University of Hamburg

Jonas Schreyoegg

University of Hamburg - Faculty of Economics and Business Administration

Date Written: December 1, 2005

Abstract

The issue of defining health benefit catalogues has recently gained new importance in Germany as a result of the creation of the new Institute for Quality and Efficiency. The Institute was designed to support the Federal Joint Committee conducting effectiveness studies for benefit coverage decisions. The Committee and the contractual partners (sickness funds and providers) define the benefit catalogues for the Statutory Health Insurance in the framework of Social Code Book V, Germany's most relevant health care scheme. Unlike other countries, the German federal government limits its regulatory role to defining procedures that determine the scope of Statutory Health Insurance services. The explicitness of the benefit catalogues varies greatly between different sectors. While benefits in outpatient care are rather explicitly defined, benefit definitions for inpatient care are vague. It is argued that the establishment of the new Institute and the development of the DRG system are initial steps towards a more effective and explicit benefit catalogue.

Suggested Citation

Busse, Reinhard and Stargardt, Tom and Schreyoegg, Jonas, Determining the 'Health Benefit Basket' of the Statutory Health Insurance Scheme in Germany: Methodologies and Criteria (December 1, 2005). European Journal of Health Economics, Vol. 6, No. 1, pp. 30-36, Dec. 2005. Available at SSRN: https://ssrn.com/abstract=1574182

Reinhard Busse

Technische Universität Berlin (TU Berlin) ( email )

Straße des 17
Juni 135
Berlin, 10623
Germany

Tom Stargardt

University of Hamburg ( email )

Hamburg Center for Health Economics
Esplanade 36
Hamburg, 20354
Germany

Jonas Schreyoegg (Contact Author)

University of Hamburg - Faculty of Economics and Business Administration ( email )

Von-Melle-Park 5
Hamburg, 20146
Germany

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