Statutory health insurance financial structure and quality further development law
| Basic data | |
|---|---|
| Title: | Law on the further development of the financial structure and quality in statutory health insurance |
| Short title: | Statutory health insurance financial structure and quality development law |
| Abbreviation: | GKV-FQWG |
| Type: | Federal law |
| Scope: | Federal Republic of Germany |
| Legal matter: | Social law |
| Issued on: | July 21, 2014 ( BGBl. I p. 1133 ) |
| Entry into force on: | January 1, 2015 |
| Last change by: |
Art. 11 G of July 16, 2015 ( Federal Law Gazette I p. 1211, 1242 ) |
| Effective date of the last change: |
July 23, 2015 (Art. 20 G of July 16, 2015) |
| GESTA : | M009 |
| Weblink: | Text of the law |
| Please note the note on the applicable legal version. | |
The law on the further development of the financial structure and quality in statutory health insurance (GKV-Finanzstruktur- und Qualität-Weiterentwicklungsgesetz - GKV-FQWG) was passed on June 5, 2014 by the German Bundestag and came into force on January 1, 2015. It did not require the approval of the Federal Council .
Contribution rates
As of January 1, 2015, the GKV-FQWG reduced the general statutory health insurance contribution rate to 14.6 percent (previously 15.5 percent). Employees and employers each pay half of the contribution rate, i.e. 7.3 percent. This means that the share of 0.9 percent that was previously only to be paid by GKV members is no longer applicable, but the statutory health insurances can levy income-dependent additional contributions from their insured persons as part of their contribution autonomy.
Special right of termination
If a health insurance company is charging for the first time or if it increases the additional contributions already required, the members of this carrier have a special right of termination . The health fund must inform the insured about this option in a separate letter. In the letter, reference must be made to the amount of the average GKV additional contribution and to the overview of the National Association of Statutory Health Insurance Funds, in which the additional contributions levied by all health insurers are listed. If the additional contribution of a health insurance company exceeds the average GKV additional contribution, the option to switch to a cheaper health insurance company must also be pointed out.
The average GKV additional contribution in 2015 was 0.9 percent.
Quality institute
Article 1 No. 7 of the GKV-FQWG defines that the Federal Joint Committee (G-BA) is to establish a professionally independent, scientific institute for quality assurance and transparency in the health care system . To this end, the G-BA is establishing a foundation under private law. The quality institute works both on quality assurance measures and on presenting the quality of care in the healthcare system.
Provision of midwifery help
In the GKV-FQWG, regulations have been included with which midwives can be financially relieved of their payment obligations in professional liability insurance by receiving security surcharges.
Independent patient counseling (UPD)
The law also regulates increasing the UPD funding to 9 million euros. There are 21 UPD advice centers nationwide. Information on health, legal and psychosocial issues is provided there by telephone or on site. The purpose of the funding is to improve accessibility by telephone in particular. The increase in funding will come into effect on January 1, 2016.
PEPP
The GKV-FQWG regulates the extension of the introductory phase of the flat-rate remuneration system for psychiatric and psychosomatic hospitals and specialist departments (PEPP) by two years. This means that psychiatric and psychosomatic facilities can also decide freely in 2015 and 2016 whether they want to use the new or the old remuneration system.
aims
With the GKV-FQWG, the federal government wants to continue to ensure high-quality health care without unnecessary burdens for those insured by the statutory health insurance system by permanently consolidating the financial structure of statutory health insurance. The law is intended to ensure fair competition and strengthen the quality of care.
Opinions and criticism
Association of Substitute Funds (vdek)
The vdek welcomes the fact that health insurances have to raise additional funds via a flat-rate additional contribution. According to the vdek, the principle inherent in the statutory health insurance system of redistributing the burden via an income-related contribution collection is confirmed. Ultimately, contribution rate autonomy, solidarity and thus the statutory health insurance as a whole would be strengthened. It is criticized that there are no rules according to which the general contribution rate and thus the employer's contribution can be adjusted in the future. In addition, a mechanism would be needed to ensure that employers also make their contribution to solidarity-based responsibility for health care and support future increases in expenditure. The vdek also has concerns about the federal subsidy, which the state pays to the health fund to refinance state (non-insurance) services through the statutory health insurance system, because according to the vdek this has been repeatedly cut to the disadvantage of the statutory health insurance system in recent years. That is why the vdek demands that the liquidity reserve of the health fund, which must be maintained, is given an upper limit. Excess funds would then be returned to the coffers and thus to the contributors.
German Hospital Society (DKG)
The DKG makes in a press release it clear that the anticipated growing financing needs for medical services is made more difficult for the additional posts and warned that such must not come to the dominance of price competition at every performance even in raising funds. The quality institute introduced by law is welcomed: The hospitals associate it with the expectation that quality assurance and quality reporting will be placed on a new, scientifically sound and objective basis. The clinics also supported the improved information and transparency regulations for patients. The clarification that has come into law through an amendment request that information on performance assessments must always be risk-adjusted is rated as positive. "With this, the legislature underlines that the assessment of medical services by hospitals is a very complicated process in which a large number of highly differentiated and patient-specific aspects have to be taken into account," said the DKG.
German Midwives Association (DHV)
The DHV believes that the GKV-FQWG would offer a new basis for further negotiations with the health insurance companies. The increases in liability insurance costs would be absorbed for some of the midwives working in obstetrics. However, the security surcharge does not offer a long-term solution, because as of July 2016 there would be no more insurers, according to the DHV, which therefore calls for the establishment of a liability upper limit with a publicly financed liability fund.
AOK federal association
The AOK Federal Association criticizes the design of the GKV-FQWG and believes that price competition is being fueled rather than appreciating the health insurance benefits, because every health insurance company whose additional contribution is above the GKV average has to inform its members about cheaper health insurance companies.
Web links
Individual evidence
- ↑ a b c d e f Press release from the Federal Ministry of Health on the GKV-FQWG
- ↑ Information from the National Association of Statutory Health Insurance Funds on the additional contribution ( Memento of the original from January 18, 2015 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Art. 1 No. 7 GKV-FQWG
- ↑ Information from the Federal Ministry of Health on the GKV-FQWG
- ^ Association of Substitute Funds (vdek) for the GKV-FQWG: For more self-administration and autonomy
- ↑ Press release of the DKG on the adoption of the GKV-FQWG
- ↑ www.aerzteblatt.de on the GKV-FQWG
- ↑ AOK Federal Association for the Dominance of Price Competition ( Memento of the original from February 11, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
