2002-11: Healthcare Situation in Germany - A Political Update

Guest article for IJMM by Joachim M. Schmitt, Director General BVMed, November 2002

German Chancellor Gerhard Schröder is planning a joint campaign modeled for resolving the problems of the statutory pension insurance and the statutory health insurance. The Chancellor intends to integrate in the new commission all parties concerned in a reform of the German health care system. Head of the Commission will be Prof. Bert Rürup. His task is to prepare „Health Care Reform 2004“.

Germany is not the only country heading a desperate need for reforms. Throughout Europe, there is an ongoing debate about the future development and financing of healthcare systems. A well-functioning system is a high social and political priority and as the countries of Europe draw closer together, an important local factor. Unquestionably, the greatest demands on the healthcare system come from the increasingly elderly population and from advances in medical technology.

In BVMed’s opinion, one of the most important health political questions of the next four years is: Will we manage, even in the coming years, to offer patients innovative medical technologies without delay? Germany needs conditions that actively encourage innovations so that new technologies and procedures can be developed. Innovation in medical technology must be better supported and adopted speedily into the DRG catalogue and the catalogues of reimbursable procedures of the health insurance funds. The aim must be to offer advanced medical technology to all patients who require it, without delay.

If we want to be able to offer medical progress to all patients within a health service funded by a solidarity system, then all parties must be aware that either contribution levels will have to rise, or alternative financing methods must be found. No health system in the world, including the German system, can promise an unlimited amount of procedures with limited funds.

Innovation-friendly conditions

For the medical technology industry, one major concern is, that innovative medical technologies must not be withheld from patients. BVMed therefore demands innovation-friendly conditions in the German healthcare system and more planning security for medical device manufacturers.

BVMed is demanding the removal of existing obstacles to innovation, such as the non-transparent decision-making procedures of the federal committees concerning new diagnosis and treatment methods, sectoral budgeting and the present lack of quality standards in treatment.

Decision makers in healthcare have to realize, that new treatment methods in the medical technology sector and new therapies reduce the patient’s recovery period and thus allow the patient a more rapid return to society and employment. All in all, this also represents a benefit for the economy.

Seven Points Programm

BVMed is presenting the following seven points, which are aimed at creating a more innovation-friendly climate in Germany:

1. All partners in the health service, particularly industry and business, require planning security through continuity. This means that the time for hectic individual measures to suppress costs must now be at an end. We need a long-term, broad-based reform concept that encompasses the opposition, the federal states, the health insurance funds, the doctors, the hospitals and the manufacturers.

2. In the case of the prospective health reform, the question of finance must no longer be ignored. The expenditure policy based on income while simultaneously attempting to maintain contribution rate levels has failed. Medical advancement and demographic development have made it exceptionally necessary to introduce optional financing possibilities if the emphasis is on maintaining the solidarity system.

3. Sectoral budgeting must be dispensed with. It hinders innovation and leads to a rationing of healthcare procedures. The health service must orient itself according to people’s medical requirements.

4. The new DRG reimbursement system for hospitals must remain accessible to medical technology. What is required is a range of flexible solutions between contractual partners at a local level, in order to allow for the adoption of innovations outside of the annually revised DRG catalogue.

5. The relative weights in the DRG catalogue must not be allowed to become a disadvantage for innovative medical technological procedures. In the existing DRG catalogue numerous relative weights for DRGs involving high-cost equipment are seriously undervalued. The individual healthcare partners are therefore called upon to agree on appropriate relative weights for high-value medical technology procedures or to further differentiate the DRGs. Only in this manner will it be possible to guarantee future patient care with innovative medical technologies in hospitals.

6. The decision-making process of the federal committees concerning new diagnosis and treatment methods (technology evaluation – Health Technology Assessment, HTA) must be more transparent and faster. A binding clause requiring a decision-making time limit of six months at the most must be included in the federal committees’ rules of procedure. In addition, the manufacturer must be given the opportunity to be present at the session. BVMed has proposed the appointment of an expert based on the procedure under discussion.

7. Bureaucracy within the procedure required to adopt innovative products into the medical technical aids register must be reduced and the process must be speeded up. A binding clause requiring a maximum decision-making process of two months must be introduced. In addition, it is important to develop quality standards for the medical technical aids sector and for homecare therapy that incorporates innovative products and procedures. The manufacturer must be involved in the development of these quality standards.

The main aim of the further development of the health care system in Germany must be to guarantee the population qualitative, high-value healthcare in the future. Serious health risks should also be effectively attended to in the future on the basis of solidarity. BVMed is convinced that all the partners within the health service must work together to create a modern health system that will guarantee that it:


creates incentives for optimum care


allows for the introduction of innovative, efficient medical technologies without delay and


allows for the best possible use of existing information technology for patients, users and all other healthcare partners.

Joachim M. Schmitt
Berlin, November 2002
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