Individual performance remuneration

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

In the German healthcare system, the remuneration for treating a patient can be made up of individual service remuneration . The reward for a treatment is divided into individual treatment steps, each of which is rated with a rating number in points. The individual fee point is multiplied by the specified point value in euros and results in the fee for the respective treatment step. The sum of the individual (dental) medical services results in the total fee for one treatment or one treatment case .

Each individual (dental) medical service, such as the examination (clinical, technical equipment), x-rays or therapeutic services such as injections , operations are covered in the uniform assessment standard for doctors - EBM or assessment standard for dentists (BEMA), in the fee schedule for doctors (GOÄ ) and the fee schedule for dentists (GOZ) with a value.

Forms of remuneration

In contrast to the remuneration for individual services, there is flat-rate compensation , for example as a case flat rate for the treatment of a defined illness or as a registration flat rate for a period of time as in the English state pension system.

The current German billing practice represents a mixed form, in which most medical services are added individually with their points, but the point value is only calculated by dividing the fee pool of a billing group (doctor group of an association of statutory health insurance physicians ) by the total of the associated Points submitted to doctors for a quarter result. The fee pots have been filled by the health insurances with individual head lump sums per member since 1993 and distributed quarterly to the billing doctors by the statutory health insurance associations according to the fee distribution standard determined by the KV .

Cost risk

The health-economic effect of the (medical) remuneration as an individual service remuneration (and furthermore for all activities and institutions in the health care system) or as a flat-rate remuneration becomes clear in the distribution of the cost risk. The costs incurred in the supply of a region in a given period of health care depend on the frequency of diseases (eg. Flu - epidemic ) and the severity of the particular disease (Asian flu with high treatment costs or trivial form of low cost).

In the case of remuneration for individual services , the cost risk in terms of both frequency and severity lies with the patient (possibly the insurance company). With the flat rate per capita , this risk of frequency and severity lies with the service provider (doctors, hospitals, etc.). A flat rate per case distributes the cost risk of care between the service provider and the patient (insurance company). The cost risk of the severity of the disease to be treated lies with the service providers; this is independent of the risk of the frequency of the disease which is to be borne by the patient as a whole (the insurance company).