National Association of Health Insurance Funds

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National Association of Health Insurance Funds
logo
social insurance Statutory health insurance , long-term care insurance
legal form Public corporation
founding July 3, 2007
Seat Berlin
Board Doris Pfeiffer (Chairman)
Supervisory authority Federal Ministry of Health
Employee 600
Website www.gkv-spitzenverband.de

The National Association of Health Insurance Funds , according to the statutes in legal and business transactions GKV-Spitzenverband , has been the nationwide association of health insurance companies in Germany since July 1, 2008 . In the statutory health insurance , as a corporation under public law, the tasks of the health insurance companies in joint self-administration as well as at international level have been assigned to him. In long-term care insurance , the association performs the tasks of the central association of the Bund der Pflegekassen.

history

The statutory health insurance is decentralized in many health insurance companies, in turn, certain insurance types belong: General local , operating , replacement and Innungskrankenkasse and Agricultural sickness and Miners . The Artists' Social Insurance Fund is not a health insurance fund according to Section 4 of the Social Code Book V, it was not one of the previous umbrella organizations and is therefore not a member of the GKV umbrella association. The replacement funds were and are free to form associations. The other associations existed by law as corporations under public law. As a result, the earlier health insurance associations differed in their legal form from the central associations of German statutory accident insurance and the Association of German Pension Insurance Institutions . In each federal state, the health insurance companies form state associations of health insurance companies as corporations under public law ( Section 207 SGB ​​V). The regional associations for their part formed a federal association for each type of health insurance fund as a central association, also in the legal form of a public corporation. There were a total of seven central health insurance associations at the federal level.

In the course of the 2007 health reform , this structure of the administrative bodies was fundamentally reformed. The GKV Competition Strengthening Act (GKV-WSG) ensured a comprehensive organizational reform. The National Association of Health Insurance Funds took the place of the previous federal associations on July 1, 2008. At the same time, the previous umbrella associations of the health insurance funds were converted by law into companies under civil law with effect from January 1, 2009 , Section 212 I 1 SGB V. They are thus the legal successors of the previous federal associations and handle their remaining liabilities, while the state associations continue to exist as before . The health insurance companies decide for themselves whether the companies should continue to exist. Their previous responsibilities, especially in joint self-administration, were transferred to the newly founded National Association of Statutory Health Insurance Funds. Since then, this has been formed by all health insurance companies; they belong directly to the umbrella association, § 217a I SGB V.

The legislature justified this reorganization of the associations with the dismantling of bureaucracy and the aim of creating more transparency at all levels. This should also serve efficiency: the association structures should be streamlined by the establishment of the National Association of Statutory Health Insurance Funds “in order to shorten decision-making processes. Instead of the previous seven, only one central federal association will in future represent all health insurers in the joint self-administration for all matters that are regulated jointly and uniformly. ”In the run-up to the reform, it was particularly criticized that the federal associations had become too costly.

It was disputed whether this goal could be achieved. It was criticized that the regional associations continued to exist alongside the new umbrella association. It is “to be expected that the health insurers will increasingly articulate their interests from the state associations and thus in competition with the one central association and the G-BA . The individual health insurers will increasingly seek contact with the statutory health insurance associations , the federal states - and thus cause the National Association of Statutory Health Insurance Physicians to become increasingly less important. Instead of the legally intended standardization and streamlining of the decision-making process, a further tightening process of disintegration will take place, which will make the work of the G-BA in the negotiation of nationwide uniform standards and fees much more difficult. This will also not help improve the situation of outpatient care compared to inpatient care. And the desired integrated care will inevitably suffer. ”The constitutionality of the transfer of responsibilities from the previous seven to only one central association has been questioned. This centralization is also contrary to the purpose of the law, which is to strengthen competition among health insurers. The self-administration is thereby "pushed into an extra role". The former Federal Minister of Health Norbert Blüm criticized the fact that, together with the introduction of the health fund at the same time, the unified umbrella association of health insurers - “an authority of state grace, the Ministry of Health has it in hand” - “is on the way to a unified fund”.

It was also controversial whether the seat of the association should be in Bonn or Berlin.

The association was founded by the statutes of June 18, 2007, which were approved by the Federal Ministry of Health as the supervisory authority on July 3, 2007.

organization

The National Association of Statutory Health Insurance Funds is a corporation under public law . According to § 217b , § 217c SGB ​​V, it has organs

  • a board of directors made up of 52 members, elected by the general assembly,
  • a board of directors made up of a maximum of three people, elected by the board of directors for six years and who represents the association externally
  • as well as the general assembly, which is formed by the health insurance companies as member funds.

The alternating chairmen of the board of directors are Volker Hansen and Uwe Klemens.

The CEO is Doris Pfeiffer, and the Deputy CEO since July 1, 2019, is Gernot Kiefer, who has been a member of the Executive Board since April 2010. Stefanie Stoff-Ahnis has been the third member of the board since July 1, 2019.

The association is financed by the member funds.

The supervisory authority is the Federal Ministry of Health .

tasks

The tasks of the National Association of Health Insurance Funds are determined by law, Section 217f I SGB V. By way of organ lending , the Association, like the health insurance funds themselves, also acts for long-term care insurance and performs the tasks of the Central Association of Long-Term Care Funds, Section 53 SGB XI.

Joint self-administration

The National Association of Statutory Health Insurance Funds represents the health insurers in the committees of joint self-administration, in particular in the Federal Joint Committee when adopting guidelines in which the detailed provisions on statutory medical care are made that are binding for the insured and for the service providers , § 91 , § 92 SGB ​​V, also when setting fixed amounts for drugs and aids as well as the maximum amounts for drugs as well as when concluding framework contracts and remuneration agreements for inpatient, outpatient and dental care, § 82  ff.SGB V, such as the uniform assessment standard . When the association was founded, it was assumed that the National Association of Statutory Health Insurance Funds would regulate "around 70 percent of all contracts for the health insurers" or "80 percent of service expenditure".

Support of the health insurance companies and their regional associations

According to § 217f II – VII SGB V there is also a responsibility for the fulfillment of the tasks and for the protection of the interests of the member funds. This includes, in particular, the design of telematics and electronic data exchange in the healthcare sector.

Medical service of the umbrella association of the health insurance funds

With effect from July 1, 2008, the former medical service of the central associations of the health insurance funds was transferred to the umbrella organization of the Federation of Health Insurance Funds. Since then, he has been the medical service of the National Association of Health Insurance Funds ( MDS ) with the legal form of the registered association , § 282 SGB ​​V.

Responsibilities at the international level

According to § 219a SGB ​​V, the National Association of Health Insurance Funds performs the tasks of the German Liaison Office for Health Insurance - Abroad ( Liaison Office ).

Together with the umbrella organizations of the German Social Accident Insurance and the German Pension Insurance Association , the National Association of Statutory Health Insurance Funds supports the German Social Insurance Working Group Europe ( DSVAE ) and the European Social Insurance Platform ( ESIP ), an amalgamation of national European social insurance organizations. In the Medicine Evaluation Committee ( MEDEV ), the National Association of Statutory Health Insurance Funds takes part in the exchange of information and experience on therapeutic added value and reimbursement systems for drugs together with other national organizations of social health insurance and national institutions responsible for the evaluation of drugs.

At the international level, the National Association of Statutory Health Insurance Funds participates in the International Social Security Association (ISSA) with other national authorities, agencies and other bodies in the field of social security . The National Association of Statutory Health Insurance Funds also takes part in informal forums, such as the G8 dementia summit in London. The World Social Security Forum takes place every three years in one of the member states and brings together delegates from 150 countries.

Web links

Individual evidence

  1. ↑ For the earlier organization and the new regulation from 2008 see § 8 Rn. 6–10 Stefan Muckel (2009): Social law . 3rd edition, Munich.
  2. ↑ Law to Strengthen Competition in Statutory Health Insurance (GKV Competition Strengthening Act - GKV-WSG) of March 26, 2007 ( Federal Law Gazette I p. 378 ).
  3. ↑ Draft law of the parliamentary groups of the CDU / CSU and SPD: Draft of a law to strengthen competition in statutory health insurance (GKV Competition Strengthening Act - GKV-WSG) . BT-Drs. 16/3100 of October 24, 2006, p. 2.
  4. ↑ Karl Lauterbach: Stenographic Protocol No. 16/80 of February 2, 2007, p. 8033.
  5. ^ A b Samir Discounta: Reform of the statutory health insurance: On the short leash . In: Deutsches Ärzteblatt. 2007; 104 (23): A-1628 / B-1439 / C-1379. Retrieved April 24, 2013.
  6. ↑ Jürgen Dahlkamp, ​​Udo Ludwig, Heiko Martens, Cordula Meyer, Alexander Neubacher, Michael Sauga: Collective irresponsible . In: Der Spiegel . No. 27 , 2006, p. 18, 27 ( online ).
  7. ↑ Eike Hovermann: Stenographic Protocol No. 16/80 (PDF) of February 2, 2007, p. 8095.
  8. ↑ Katherina Reiche: Stenographic Protocol No. 16/80 of February 2, 2007, p. 8102.
  9. ↑ Hilde Mattheis, Lothar Mark, Ewald Schurer, Klaus Barthel, Renate Gradistanac, Angelika Graf (Rosenheim), Bärbel Kofler, Ottmar Schreiner: Stenographic Protocol No. 16/80 of February 2, 2007, p. 8107.
  10. ↑ a b Norbert Blüm: On the way to the uniform fund. At the start of the health reform: What happens when privatizers and nationalists make common cause . In: Die Zeit , No. 2/2009.
  11. ↑ Stenographic Protocol No. 16/80 of February 2, 2007, pp. 8035, 8041, 8108.
  12. ^ Administrative board of the National Association of Statutory Health Insurance Funds . Retrieved March 31, 2013.
  13. ^ Board of Directors of the National Association of Statutory Health Insurance Funds . Website of the National Association of Statutory Health Insurance Funds, accessed on September 23, 2016.
  14. ↑ Doris Pfeiffer leads the GKV. In: FAZ , June 20, 2007.
  15. ^ German liaison office for health insurance abroad . Retrieved April 25, 2014.
  16. ↑ German social insurance - Arbeitsgemeinschaft Europa e. V. (DSVAE) . Retrieved April 23, 2014.
  17. ^ European Social Insurance Platform (ESIP) . Retrieved April 23, 2014.
  18. ↑ International Social Security Association . Retrieved April 24, 2014.
  19. ^ National Association of Statutory Health Insurance Funds: Tasks and Objectives ( Memento of the original from August 24, 2012 in the Internet Archive ) Info: The @1@ 2Template: Webachiv / IABot / www.gkv-spitzenverband.de archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. . April 16, 2014. Retrieved April 24, 2014.