[Competition among health insurers from the perspective of a statutory health insurance company].
In the wake of the new healthcare legislation the German statutory health insurers--about 200 health plans of statutory health insurances--find themselves in tight competition. Since 2009 the health insurers have obtained their money from a centralised health fund (Gesundheitsfonds). If the financial contributions from this fund fail to cover costs the funds are forced to raise an additional premium from their insured members who, in turn, may immediately switch to another insurance company. By implementing this new system of a Gesundheitsfonds the old risk structure compensation scheme has been redesigned. Now the cost-predicting factors do not only include age and sex, but also additional ones like diagnosis of in- and outpatient care (morbidity factor). This approach to risk compensation is an essential prerequisite for "solidarity-based" competition. Sickness funds now concentrate their efforts on care management in order to achieve cost-effectiveness and to ensure quality in healthcare, which is their actual aim. This, however, requires further options of selective contracting with single providers or groups of providers.
Fischer
Birgit
B
Barmer, Wuppertal. birgit.fischer@barmer.de
D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D004465:Economic Competition; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients; D007343:Insurance Carriers / Q000191:economics* / Q000331:legislation & jurisprudence*; D008297:Male; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence; D010045:Outpatients; D012306:Risk