Details
| Original language | English |
|---|---|
| Pages (from-to) | S20-S30 |
| Journal | Value in health |
| Volume | 6 |
| Issue number | SUPPL. 1 |
| Early online date | 8 Jul 2003 |
| Publication status | Published - Jul 2003 |
Abstract
Objective: Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is percapita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. Methods: This article describes and analyzes these governmental initiatives as well as other market reforms. Results: Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. Conclusions: To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.
Keywords
- Disease management, Drug budget, Health technology assessment, Negative list, Positive list
ASJC Scopus subject areas
- Medicine(all)
- Health Policy
- Medicine(all)
- Public Health, Environmental and Occupational Health
Sustainable Development Goals
Cite this
- Standard
- Harvard
- Apa
- Vancouver
- BibTeX
- RIS
In: Value in health, Vol. 6, No. SUPPL. 1, 07.2003, p. S20-S30.
Research output: Contribution to journal › Review article › Research › peer review
}
TY - JOUR
T1 - Using Disease Management and Market Reforms to Address the Adverse Economic Effects of Drug Budgets and Price and Reimbursement Regulations in Germany
AU - Schwermann, Tim
AU - Greiner, Wolfgang
AU - Schulenburg, J. M.Graf V.D.
PY - 2003/7
Y1 - 2003/7
N2 - Objective: Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is percapita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. Methods: This article describes and analyzes these governmental initiatives as well as other market reforms. Results: Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. Conclusions: To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.
AB - Objective: Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is percapita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. Methods: This article describes and analyzes these governmental initiatives as well as other market reforms. Results: Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. Conclusions: To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.
KW - Disease management
KW - Drug budget
KW - Health technology assessment
KW - Negative list
KW - Positive list
UR - http://www.scopus.com/inward/record.url?scp=0042532265&partnerID=8YFLogxK
U2 - 10.1046/j.1524-4733.6.s1.3.x
DO - 10.1046/j.1524-4733.6.s1.3.x
M3 - Review article
C2 - 12846923
AN - SCOPUS:0042532265
VL - 6
SP - S20-S30
JO - Value in health
JF - Value in health
SN - 1098-3015
IS - SUPPL. 1
ER -