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Authors: Timo Emcke 1 ; Thomas Ostermann 2 ; Marc Heidbreder 3 and Reinhard Schuster 3

Affiliations: 1 Association of Statutory Health Insurance Physicians, Germany ; 2 Witten/Herdecke University, Germany ; 3 Medical Advisory Board of Statutory Health Insurance in Northern Germany, Germany

Keyword(s): Controlling Measures, Outpatient Care, Morbidity Adjusted Benchmark, Prescription Data, MRG, Big Data.

Related Ontology Subjects/Areas/Topics: Biomedical Engineering ; Health Information Systems ; Healthcare Management Systems

Abstract: German legislation demands controlling measures for outpatient drug costs. As of 2017 the health insurance actors rose to a challenge to reform the benchmark system on the federal state level. We look at the previous system applied until 2015, the improvements in 2016 and the method the regional parties agree on for 2017. After discussing hard- and software systems and the underlying data briefly we describe the flaws of the old approach and develop a general model for controlling measures in the outpatient field. Finally we present the first real world applications of the new model: a patient type classification system leading to target costs and a derived distance structure of physicians regarding their prescription behaviour.

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Paper citation in several formats:
Emcke, T.; Ostermann, T.; Heidbreder, M. and Schuster, R. (2017). Comparison of Different Implementations of a Process Limiting Pharmaceutical Expenditures Required by German Law. In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017) - HEALTHINF; ISBN 978-989-758-213-4; ISSN 2184-4305, SciTePress, pages 35-40. DOI: 10.5220/0006114800350040

@conference{healthinf17,
author={Timo Emcke. and Thomas Ostermann. and Marc Heidbreder. and Reinhard Schuster.},
title={Comparison of Different Implementations of a Process Limiting Pharmaceutical Expenditures Required by German Law},
booktitle={Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017) - HEALTHINF},
year={2017},
pages={35-40},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0006114800350040},
isbn={978-989-758-213-4},
issn={2184-4305},
}

TY - CONF

JO - Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017) - HEALTHINF
TI - Comparison of Different Implementations of a Process Limiting Pharmaceutical Expenditures Required by German Law
SN - 978-989-758-213-4
IS - 2184-4305
AU - Emcke, T.
AU - Ostermann, T.
AU - Heidbreder, M.
AU - Schuster, R.
PY - 2017
SP - 35
EP - 40
DO - 10.5220/0006114800350040
PB - SciTePress

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