Federal Joint Committee
The Federal Joint Committee ( G-BA ) is the highest body of self-administration in the health system in Germany . It is mandated by the legislature to make legally binding decisions in many areas about the benefit entitlement of the community of solidarity of around 73 million people with statutory health insurance in Germany. The organization is based in Berlin-Charlottenburg.
Legal basis; development
The legal basis for the Federal Joint Committee is Fifth Book of the Social Code (SGB V), introduced by the law on the modernization of statutory health insurance (GMG) that came into force on January 1, 2004 . The predecessor institution was in particular the Federal Committee of Doctors and Health Insurance Funds established by the Law on Health Insurance Physicians Law of 1955, which in turn was linked to the Reich Committee of Doctors and Health Insurance Funds established in 1923. Following this pattern, a federal committee of dentists and health insurance companies, a hospital committee and a coordination committee were established in the following years. These committees were transferred to the Federal Joint Committee.the
SGB V prescribes that statutory health insurance (GKV) benefits must be "sufficient, appropriate and economical". According to SGB V, they may “not exceed what is necessary” (economic efficiency requirement). In addition, the law requires that the diagnostic or therapeutic benefit, the medical necessity and the profitability of services must be proven before they can become part of the GKV service catalog.
The G-BA essentially fulfills the tasks assigned by the legislator by adopting guidelines or updating existing ones, for example the Medical Aids Directive , the Therapeutic Products Directive or the Drugs Directive . Although these guidelines are ranked below the law (subordinate standard character), they are nevertheless legally binding for all those with statutory health insurance and those involved in the GKV. They apply to outpatient treatment by resident doctors, dentists, therapists and psychotherapists as well as for treatments in hospitals and clinics.
The G-BA receives its legal mandate and thus its legal legitimation from the Bundestag and Bundesrat in Germany. The G-BA is an independent legal entity under public law and is under the legal supervision of the Federal Ministry of Health (BMG).
The G-BA is not a subordinate authority, but an organ of indirect state administration , to which more and more sovereign, state tasks have been delegated in recent years. The decisions of the G-BA must be submitted to the BMG for review. However, the ministry's review is limited to the legally correct conclusion of the resolutions. A technical and content-related review by the ministry is not provided by law. There have been repeated disputes, including in court, about the scope and limits of the Ministry's ability to influence the content of the legal review.
In December 2016, the Federal Ministry of Health commissioned three independent legal opinions on the question of the constitutional legitimacy of the G-BA to issue guidelines and other normative decisions. The background to the assignment was the information contained in the case law of the Federal Constitutional Court, which gave rise to a comprehensive legal analysis of the various legal bases for the regulatory mandates of the G-BA. The BMG commissioned Ulrich M. Gassner (University of Augsburg), Thorsten Kingreen (University of Regensburg) and Winfried Kluth (University of Halle-Wittenberg) as reviewers . The reports prepared reflect the range of positions represented in law with regard to the constitutional legitimacy of the G-BA and can be accessed on the BMG website.
Tasks and way of working
The establishment of the group resulted in the grouping of the following five committees, which had previously worked side by side:
- Federal Committee of Doctors and Health Insurance Companies
- Federal Committee of Dentists and Health Insurance Companies
- Federal Committee for Questions of Psychotherapy
- Coordination committee
- Hospital Committee
He makes a variety of decisions on questions of health care within the framework of statutory health insurance. He is also entrusted with quality assurance and quality management tasks. The committee is supported by expert opinions from the Institute for Quality and Efficiency in Health Care . Its working method is laid down in rules of procedure and procedural rules, which the Federal Joint Committee itself decides, but which require the approval or non-objection of the Federal Ministry of Health.
In particular, he has general competence to exclude or limit services if, according to the general state of medical knowledge, the diagnostic or therapeutic benefit, the medical necessity or the economic viability have not been proven. Other essential tasks include the adoption of guidelines that specify the individual services for contract doctors, hospitals, insured persons and health insurance companies, for example in the areas of medical and dental treatment, early diagnosis, needs planning, home nursing and pharmaceuticals. The committee finally has to decide on the approval of new examination and treatment methods for statutory health insurance and to determine drug groups for which fixed amounts can be set.
For example, in the area of disease management programs (DMP) in accordance with SGB V , the G-BA has adopted guidelines for diabetes mellitus type 1 and diabetes mellitus type 2, breast cancer and coronary heart disease as well as recommendations for bronchial asthma and chronic obstructive pulmonary disease .
The G-BA sets up sub-committees to prepare its decisions. Currently (May 2019) are the nine subcommittees drugs , quality assurance , disease management programs , outpatient specialty specialist care , methods evaluation , Prescribed benefits , requirements planning , psychotherapy and dental treatment . In contrast to the plenary, the sub-committees meet exclusively in closed sessions. They consist of an impartial chairman (one of the three impartial members of the plenary), six representatives of the payers and six representatives of the care providers. The Federal Joint Committee publishes the names of the impartial chairmen, but not the names of the other members of the subcommittees. Patient representatives take part in the meetings to give their opinion. The sub-committees forward the results of their deliberations to the plenary as a recommendation for a resolution.
The committee has 13 voting members. The term of office of the plenary members is six years.
It consists of five representatives of the payers (sent by the National Association of Health Insurance Funds (GKV-Spitzenverband)), five representatives of the service providers, represented by two named members of the German Hospital Society (DKG), two named members of the National Association of Statutory Health Insurance Physicians (KBV) and one named member of the National Association of Statutory Health Insurance Dentists (KZBV). Representatives of the National Association of Statutory Health Insurance Funds are currently (May 2019) Doris Pfeiffer, Johann-Magnus von Stackelberg, Gernot Kiefer, Ulrike Hauffe and Dieter Landrock. The service providers are represented by Andreas Gassen (KBV), Stephan Hofmeister (KBV), Gerald Gaß (DKG), Georg Baum (DKG) and Wolfgang Eßer (KZBV).
There are also three impartial members, one of whom is the chairman of the committee. The impartial chairman is currently (September 2019) Josef Hecken , his first deputy is Friedhelm Hase . Other impartial members are Monika Lelgemann and Elisabeth Pott . The above-mentioned representatives of the cost bearers and service providers must agree on the three impartial parties, otherwise they will be appointed by the Federal Ministry of Health (BMG). Rainer Hess was the impartial chairman from the establishment of the Federal Joint Committee in 2004 to 2012 .
Up to five general patient representatives as well as five subject-related patient representatives take part in plenary and committee meetings in an advisory capacity, have the right to propose and vote before voting, but are not entitled to vote. They are named on the basis of SGB V by mutual agreement by the associations qualified for this in accordance with the Patients Participation Ordinance (PatBeteiligungsV):
- German Disability Council
- Federal working group of patient centers and initiatives
- German Association support groups eV
- Consumer Bundesverband e. V.
The G-BA was accused of being an instrument of health insurances and politics for rationing in health care at the expense of patients . The G-BA is often referred to as the “minor legislature” or the “Central Committee of the Health System”.
Patient representatives of the Deutsche Aidshilfe , who took part in the negotiations of the G-BA in 2010 to transfer heroin-assisted treatment into standard care, reported a "rude tone - flanked by personal attacks". From their point of view, the committee members seemed to be concerned primarily with enforcing their ideologically motivated rejection of this treatment, which had already become clear in hearings by the Bundestag, through excessive demands.
The German Foundation for Patient Protection , which takes care of the seriously ill and the dying, now also wants to send representatives to the Federal Joint Committee. The Ministry of Health refused. In this context, a lawsuit is pending at the Düsseldorf Social Court (Az .: S11 KR 331/14). The foundation is suing the Federal Republic of Germany.
Medical associations and health insurances are currently calling for more transparency in the G-BA's decisions with the Berlin political advisor Albrecht Kloepfer. The committee that determines the statutory health insurance benefits only meets partially publicly and it is sometimes impossible to understand who is behind the decisions. From a “democratic point of view it is difficult,” Kloepfer told Die Welt newspaper .
In January 2019, plans by the Federal Minister of Health Jens Spahn became known who, by means of a new "Appointment Service and Supply Act", would like to authorize the ministry in future to decide, without the participation of the G-BA, which examination and treatment methods must be covered by the health insurance companies.
The decision of the G-BA not to extend the telephone sick leave of patients with respiratory diseases during the COVID-19 pandemic in Germany beyond April 19, was massively criticized by doctors, unions and consumer advocates. Doctors spoke of "epidemic hygienic nonsense" which "jeopardizes previous successes in combating the pandemic". The exemption was then extended to May 4th.
Criticism of the designation
The name Federal Joint Committee does not in any way indicate in which area the body is active. This is what the medical journalist Eckart Roloff said in the specialist journal Dr. med. Mabuse (Volume 39, No. 208 of March / April 2014, p. 7) noted critically. The abbreviation G-BA with the hyphen does not result from this name.
- State Committee of Doctors and Health Insurance Companies
- Health policy
- Health reform in Germany
- Prioritization of medical services
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