Binder A, Braun G E
Fakultät für Wirtschafts- und Organisationswissenschaften, Universität der Bundeswehr München, Neubiberg.
Institut für Betriebswirtschaftslehre des öffentlichen Bereichs und Gesundheitswesens, Universität der Bundeswehr München, Neubigerg.
Gesundheitswesen. 2015 Mar;77(3):206-12. doi: 10.1055/s-0034-1395565. Epub 2015 Jan 27.
Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA.
医疗服务提供商网络被视为克服德国医疗体系中广受批评的碎片化和部门分割问题的重要工具。本文第一部分将医疗服务提供商网络纳入医疗保健研究领域。为此使用了医疗保健研究的系统理论模型和基本功能。此外，还列出了与医疗服务提供商网络关系密切的已确立的医疗保健研究领域。本文第二部分介绍了一些为医疗服务提供商网络报销的创新选项，这些选项可被视为以网络为导向的医疗保健研究的一些成果。其起源是目前部分用于根据《社会法典第五卷》第140a条及以下条款报销综合护理的虚拟预算。对该模型进行描述和评估会得出实际预算（人头费）——例如，德国政府医疗保健咨询委员会（SVR-Gesundheit）多次要求的一种报销方案，但几乎未得到实施。最后一步讨论了德国疾病基金对网络的直接报销。展示了其优势和挑战。不同报销方案的发展部分基于美国的模式。
