Benefits and Limitations of Age Group-Adjusted Average in the Profitability Audit for Pharmocotherapy

Reinhard Schuster, Thomas Ostermann, Timo Emcke, Fabian Schuster, Fabian Schuster

2022

Abstract

Benchmarks for pharmaceuticals have been used for over 25 years to limit the cost increase in the second largest cost block in statutory health insurance in Germany with financial punishments for the physicians. The Regional Social Court of Dresden declares such a payback practice to be inadmissible if no age reference is used. In 2016, in most regions of the statutory health insurance associations, the division into status groups members, family members and pensioners has been changed into four age groups. The Supply Strengthening Act has opened up the possibility of drafting regional agreements. In Schleswig-Holstein, Morbidity Related Groups (MRG) were introduced for morbidity-related considerations. A number of other regions are currently using retrospective average cost limitations, which have the same problems as the benchmark restrictions. The aim of this paper is to investigate the influence of the type of health insurance (sickness) fund on the benchmark result with status and with age groups. Different morbidity structures between the health insurance funds are the subject of the risk structure compensation. For doctors, this aspect is not given sufficient consideration with respect to patient-specific morbidity characteristics till now.

Paper Citation

in Harvard Style

Schuster R., Ostermann T., Emcke T. and Schuster F. (2022). Benefits and Limitations of Age Group-Adjusted Average in the Profitability Audit for Pharmocotherapy. In Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 5: HEALTHINF; ISBN 978-989-758-552-4, SciTePress, pages 390-396. DOI: 10.5220/0010807500003123

in Bibtex Style

@conference{healthinf22,
author={Reinhard Schuster and Thomas Ostermann and Timo Emcke and Fabian Schuster},
title={Benefits and Limitations of Age Group-Adjusted Average in the Profitability Audit for Pharmocotherapy},
booktitle={Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 5: HEALTHINF},
year={2022},
pages={390-396},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0010807500003123},
isbn={978-989-758-552-4},
}

in EndNote Style

TY - CONF

JO - Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 5: HEALTHINF
TI - Benefits and Limitations of Age Group-Adjusted Average in the Profitability Audit for Pharmocotherapy
SN - 978-989-758-552-4
AU - Schuster R.
AU - Ostermann T.
AU - Emcke T.
AU - Schuster F.
PY - 2022
SP - 390
EP - 396
DO - 10.5220/0010807500003123
PB - SciTePress