Budgeting (healthcare)

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In the German health care system, budgeting refers to a measure that stipulates by law that, in a certain expenditure area, only an amount of money that corresponds to that of the previous year and can be adjusted by the percentage of the increase in the basic wage bill may be spent per calendar year for all insured persons of the statutory health insurance (Income-oriented spending policy). In order to achieve this, the principle of stable contribution rates applies : this is intended to limit increasing expenditure by statutory health insurance funds .

Contract dental budgeting

In the dental sector, the individual health insurance fund in each federal state is calculated by multiplying the number of members of a health insurance company by a health insurance fund per capita amount. This amount results in the total upper remuneration limit (= official budgeting name), which must not be exceeded. The regulatory instrument that has to ensure this is the fee distribution standard (HVM). The HVM causes either a reduction in the amount of work or the fees. On January 1, 2013, a change was made by the Statutory Health Insurance Supply Structure Act (GKV-VStG), according to which a “ reset ” of the total remuneration is to be achieved. The 2013 budget for each individual health insurance company is calculated from the point value that has been uniform for all health insurance companies in a federal state from 2013 onwards , which is multiplied by the number of points charged by each health insurance company in 2012. As a result, the requested amount of dental services is fully financed once. The aim is to eliminate the distortions that have arisen since 1993, the year that budgeting was introduced. The upheavals were caused, for example, by member migrations among health insurance companies, health insurance company mergers and the opening of previously closed health insurance companies. Budget overruns should be avoided or reduced in the future, as the previously applicable upper adjustment limit, the basic wage change rate , will no longer be the sole criterion for future adjustments:

"In the contractual dental care, the contracting parties to the overall contract agree on changes to the total remuneration, taking into account the number and structure of the insured, the development of morbidity, the cost and supply structure, the working time required for the contractual dental activity and the type and scope of the dental services, insofar they are based on a change in the statutory or statutory scope of services. "

- § 85 SGB ​​V

The agreed total remuneration for 2013 is the starting point for future contract negotiations with the individual health insurance companies and health insurance associations.

Budgeting by contracted doctors

Prepared with the Statutory Health Insurance Modernization Act and further developed by the Statutory Health Insurance Competition Enhancement Act on April 1, 2007, the previously budgeted financial volume for medical services will be decoupled from the increase in the basic wage and the fee system, which was previously characterized by floating point values , will be replaced by a fundamental reform of the remuneration of contract doctors a euro fee schedule.

Hospital budgeting

Budgeting for hospital reimbursement should end after the introduction of the Diagnosis Related Groups (DRG) at the end of the convergence phase in 2009.

Drug budgeting

The drug budget replacement law (ABAG) of 2001 abolished the budgets for medicines and drugs, cost limits in this area are made, among other things, by means of benchmarks , benchmark volume, benchmark testing, recourse and drug target agreements.

Occurring problems

With this planned economy instrument, it often happens at the end of a year that the planned expenses (total remuneration) have already been used up, even when doctors try to avoid unnecessary expenses. The reasons for this are the risk of morbidity and the incidence of diseases in the population (e.g. flu waves , epidemics ), which are not based on economic data. In these cases, doctors treat urgent cases unchanged, but bear the additional treatment costs themselves. postponable treatments will be postponed to the next calendar year.


The budgeting of treatment expenses was introduced in Germany in 1993. The expenditure of the statutory health insurances for administration, advertising and so-called "health promotion offers" (eg cooking, dance courses, etc.) were not subject to any regulation and increased accordingly. In 2004, measures were introduced in the so-called Statutory Health Insurance Modernization Act which were intended to reduce these costs.

Further cost-containment measures include, for example, degression , settlement barriers for doctors, the so-called practice fee , which should lead to a lower frequency of doctor visits, the removal or restriction of services from the GKV service catalog (e.g. in the dental sector: since January 1 2004 Tightening of the guidelines (e.g. for root canal treatments ), limitation of the billing of BEMA services (e.g. performance number 107 calculus removal calculable once per calendar year), introduction of fixed subsidies for dentures ).

See also

Basic wage bill