Health insurance companies increase drug budgets from 2011

Health insurance funds increase drug budgets from 2011: increase of the drug budget by 0.2 percent

The Central Association of Statutory Health Insurance (GKV) and the National Association of Statutory Health Insurance Physicians (KBV) have agreed on a budget increase in the area of ​​medicines and remedies. According to them, the new budget will increase the annual budget of physicians and prescribers for the prescription of medicines and remedies from 2011 by 60 million euros each.

Spending on pharmaceuticals: 30 billion euros
For example, the planned total budget for pharmaceuticals will be € 30 billion from next year, and € 4 billion for remedies such as physiotherapy, speech therapy or occupational therapy. This increases the possible expenditures of doctors on medicines by 0.2 percent and in remedies by 1.5 percent. The calculation model of the umbrella association of the GKV and the KBV is based on benchmarks for checking the economic efficiency, which specify how much a doctor may prescribe on average per patient per year. These are very different depending on the specialist group.

No significant increase - KBV still satisfied
As stated by KBV, the recommendations on lead substances and prescription rates have remained virtually unchanged in the current regime. The growth rates are relatively low compared to previous years. However, the austerity measures decided by the government in the pharmaceutical sector are taking effect in parallel, so that the KBV was quite satisfied with the current regulation. The KBV board Carl-Heinz Müller emphasized to the „German medical journal“, that the new frameworks „In view of the austerity measures (...) provided by the two pharmaceuticals legislation, this is a positive result for the contract physicians and the patients, as the benchmarks do not have to be lowered“. Thus, the slight increase in benchmarks by the KBV even considered a success. In addition, the KBV board was pleased that it „This year (...) KBV has succeeded in combining the achievement of supply and profitability objectives with a possible exemption from the benchmark test and thereby reducing the pressure of recourse for physicians“. Doctors who work economically and fully comply with their obligation to care, should therefore be spared by future benchmarks.

„Damocles sword of the benchmark test“
However, the physicians can not be completely certain in the future, because if there are any changes in the planned conversion of wholesale compensation, consequences for the doctors' budgets are also to be feared. In addition, the decision to exempt doctors from further benchmark tests is merely a recommendation. So stay tuned in the future „Damocles sword of the benchmark test“ about the contract doctors in the countries, said Carl-Heinz Müller and therefore called for a clear legal regulation to abolish the benchmarks.

Follow country-level regulations
How the framework requirements are implemented in the individual federal states, according to the KBV is not yet settled. Since the federal states differ greatly with regard to their population structure, the respective associations of statutory health insurance physicians must negotiate the concrete guidelines for medical treatment in the coming weeks. For example, setting the additional rate of increase for the number and age structure of the insured is a factor of the drug agreements that should be defined at the country level to ensure that the regional differences are taken into account. (fp, 21.10.2010)

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Picture credits: Rainer Sturm