Other Reimbursement Pathways
In addition to inpatient remuneration via the DRG system, there are a large number of forms of remuneration in the German healthcare system.
The spectrum ranges from outpatient specialist care to integrated models and new forms of care supported by the Innovation Fund.
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In the field of outpatient specialist care (ASV), the legislature has made a new attempt to loosen the outdated boundary between outpatient and inpatient care. With the new version of § 116 b of the German Social Code, Book V, it has succeeded in creating a regulation that can truly be described as innovative. The volume development of services in this area is tied to quality specifications, contract physicians and hospitals have equal rights, and fixed prices are paid.
In a project initiated by the Professional Association of German Internists (BDI), inspiring-health, Dr. Wilke GmbH has developed a methodology for the calculation of ASV-DRGs for gastrointestinal tumors (GIT) as an example.
DRG per case flat rates per se cover all costs of different treatments that occur in one stay. Thus, they correspond to the idea of reimbursing a team from the outset.
Example of the breadth of treatments in a flat rate per case
The German healthcare system is one of the most efficient in the world. The increasing proportion of older, chronically or multimorbidly ill people poses major challenges for the system.
With the GKV-Versorgungsstärkungsgesetz (SHI Care Strengthening Act), the Federal Joint Committee (G-BA) received the mandate to promote new forms of care that go beyond the previous standard care and care research projects that are aimed at gaining knowledge to improve existing care in the statutory health insurance system. The overriding goal of the Innovation Fund is to further develop the quality of care in Germany's statutory health insurance system.
The German government has set up an Innovation Fund for this purpose. The funding available amounts to 300 million euros per year in each of the years 2016 to 2019. This includes 225 million euros for the promotion of new forms of healthcare and 75 million euros for healthcare research.
The application process for the Innovation Fund was launched on April 8, 2016. From this date, project applications for new forms of healthcare and healthcare research may be submitted.