Purchasing model
The purchasing model is the concept for a changed organizational form in statutory health insurance , in which health insurance companies can conclude contracts directly with selected individual service providers or associations of service providers. The term is particularly used in the context of outpatient care, but also applies to other sectors of the health care system .
status quo
In large parts of the German healthcare system, competition is severely restricted. In outpatient care, the health insurance companies conclude contracts with the statutory health insurance associations , which have a contractual monopoly for their members. In hospital care, all health insurances conclude remuneration agreements together with the approved hospitals in accordance with the Hospital Financing Act.
Characterization of the purchasing model
The purchasing model opens up the possibility of a contractual competition . Individual health insurance companies can negotiate individual contracts with individual service providers or several providers with voluntary alliances. Associated with this are two major changes to the previous organizational form in the health care system: the health insurers no longer have to act uniformly (as was previously the case in the inpatient sector) and they no longer have to contract with all service providers (previously outpatient: all members of the Association of Statutory Health Insurance Physicians, inpatient: all approved hospitals ), but can selectively conclude contracts, so the contract obligation is largely removed. The increased introduction of the purchasing model / contract competition is mainly demanded by some large statutory health insurance companies, the associations of service providers are skeptical about this.
Implementation status
So far, the German healthcare system has only been organized according to the purchasing model in a few approaches. For example, in inpatient and outpatient rehabilitation, the health insurers already selectively conclude individual contracts with service providers. Recently, with integrated supply , another area has been added in which there is contract competition. It is the declared will of health policy to come to more contractual competition in the future.
Award decisions in the purchasing model
For the structuring of their award decisions in the purchasing model, the cash registers have a broad scope of action, as they have so far been expressly excluded from antitrust law in many areas . In addition to individual negotiations, they can also use structured procurement methods such as tenders and auctions .