Fischer Birgit
Barmer, Wuppertal.
Z Evid Fortbild Qual Gesundhwes. 2009;103(10):635-8; discussion 643. doi: 10.1016/j.zefq.2009.09.037.
In the wake of the new healthcare legislation the German statutory health insurers--about 200 health plans of statutory health insurances--find themselves in tight competition. Since 2009 the health insurers have obtained their money from a centralised health fund (Gesundheitsfonds). If the financial contributions from this fund fail to cover costs the funds are forced to raise an additional premium from their insured members who, in turn, may immediately switch to another insurance company. By implementing this new system of a Gesundheitsfonds the old risk structure compensation scheme has been redesigned. Now the cost-predicting factors do not only include age and sex, but also additional ones like diagnosis of in- and outpatient care (morbidity factor). This approach to risk compensation is an essential prerequisite for "solidarity-based" competition. Sickness funds now concentrate their efforts on care management in order to achieve cost-effectiveness and to ensure quality in healthcare, which is their actual aim. This, however, requires further options of selective contracting with single providers or groups of providers.
随着新的医疗保健立法的出台，德国法定健康保险公司——约200个法定健康保险计划——发现自己陷入了激烈的竞争。自2009年以来，健康保险公司一直从一个集中的健康基金（Gesundheitsfonds）获取资金。如果该基金的财政捐款不足以支付成本，这些基金就被迫向其参保成员提高额外保费，而参保成员反过来可能会立即转投另一家保险公司。通过实施这个新的Gesundheitsfonds系统，旧的风险结构补偿计划已经重新设计。现在，成本预测因素不仅包括年龄和性别，还包括诸如门诊和住院护理诊断（发病率因素）等其他因素。这种风险补偿方法是“基于团结”的竞争的一个基本前提。疾病基金现在将精力集中在护理管理上，以实现成本效益并确保医疗保健质量，这才是它们的实际目标。然而，这需要与单个供应商或供应商群体进行选择性签约的更多选择。
