Braun S, Prenzler A, Mittendorf T, von der Schulenburg J M
Leibniz Universität Hannover, Forschungsstelle für Gesundheitsökonomie, Königsworther Platz 1, Hannover.
Gesundheitswesen. 2009 Jan;71(1):19-23. doi: 10.1055/s-0028-1102930. Epub 2009 Jan 27.
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.
本文从法定医疗保险的角度，对德国医疗体系内相关的资源使用情况进行了系统概述，并探讨了这些资源使用在经济分析中应如何定价。这包括门诊和住院护理的所有相关成本领域，以及药物使用产生的相关数据的详细描述。对于处方，应用法律框架（如参考定价）列出所有相关的自付费用或折扣（如给制药公司的），这些在专利药和非专利药中都必须考虑。同样的方法也应用于门诊服务（考虑通用报酬方案EBM）以及住院治疗（讨论德国疾病诊断相关分组系统的某些特征）。结果，首次提出了一种务实且实用的方法，以便在未来研究中从法定医疗保险即疾病基金的角度对德国医疗体系内的资源使用进行估值。
