[Options for a future risc structure compensation in Germany].
AIM OF THE ARTICLE: The risc structure compensation scheme within the German compulsory health insurance system is intended to enforce the principle of solidarity all over the statutory health insurance and not only within the different sickness funds. Differences in the contribution rates should not reflect different risc profiles, but the differences of the efficiency in social care. The criticism against the current adjustment system in Germany is multifarious and points e. g. on the missing orientation to morbidity. This article follows the question, whether this criticism is valid.


METHODS
The variables and methods, which are currently used to calculate the risc structure adjustment are discussed and compared to an alternative proposal for the future form of the risc structure adjustment, which includes both a higher orientation to riscs and incentives for social health insurance funds to decline the costs for the social care system on long-term.


RESULTS
Currently, for the calculation of the risc structure adjustment the following variables are used: age, sex, income, number of family members who are exempted from contributions and persons who get occupational disability pension, and number of insured persons who are registered to an accredited Disease-Management-Program (DMP). Especially the last variable includes a high control effort, because the higher co-payments of the adjustment system are aligned to the voluntariness of participation and active collaboration of the patients in DMP. The argument, a further development to a morbidity-oriented risc structure adjustment leads to less cost management of the sickness funds is not totally correct, because not actual, but standardised costs are the basis for compensation. On the other hand the morbidity determined cost components should not totally be adjusted, as a proper distribution of savings to the risc structure adjustment and the single funds would still be an incentive for cost management and prevention.


CONCLUSIONS
An ongoing refining of the risc structure adjustment might cause new incentive problems. Instead a morbidity orientated risc structure compensation scheme should leave a part of the savings due to better social care structures in the sickness funds and should include outpatient care parameters. The change to a new honorarium system could create a better data basis for this improved form of risc structure adjustment in the future.
Greiner
W
W
Fakultät für Gesundheitswissenschaften, School of Public Health - WHO Collaborating Center, AG 5 - Gesundheitsökonomie und Gesundheitsmanagement, Universität Bielefeld. wolfgang.greiner@uni-bielefeld.de
D017047:Cost Sharing / Q000191:economics / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000458:organization & administration*; D020379:Risk Adjustment / Q000191:economics / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000191:economics* / Q000379:methods*; D012307:Risk Factors; D020414:Risk Sharing, Financial / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*