Fee distribution agreement
A fee distribution agreement ( HVV , until 2004 and from 2012 fee distribution standard , HVM ) regulated in Germany from 2004 to 2011 the distribution of the total remuneration provided by the health insurers through the statutory health insurance associations (KV) or statutory dental associations (KZV) to their doctors or dentists. The legal basis for fee distribution agreements was § 85 SGB V, Paragraph 4 of Book Five of the Social Code . By mid-2004, the fee distribution criteria were set by the statutory health insurance and statutory health insurance associations. Since then, the distribution of fees between health insurance associations and each individual physicians 'and dentists' association was in agreement agreed. At that time there was talk of a fee distribution agreement (HVV).
Fee distribution standard (HVM)
With the health reform of the GKV supply structure law , which came into force on January 1, 2012, this was reset to the status of 2004, i. H. the distribution of fees was again established as a statutory right of the respective KV or KZV in accordance with § 85 SGB V. Since then, the fee distribution standard has to be decided in consultation with the health insurance companies by the respective representative assembly of the KV or KZV. It regulates compliance with budgeting and is therefore an instrument for distributing deficiencies.
Calculation of the total remuneration limit
The statutory health insurance and statutory health insurance associations distribute the money from the fee pots to the doctors and dentists according to the fee distribution scale (a distribution key).
history
The health insurance paid for the medical and dental treatments for their insured from 1993 to 2008 on a pro-amount member (also called capitation different depending on the health insurance and KV / KZV-district) (with an exemption in all types of insurance specific fee pots primary or spare cash differently per subject in the order of 100 to 600 € per year). The health insurance companies did not pay a separate amount for the free co-insured spouses and children; When the amount of the head lump sum was first determined in 1993, the volume of benefits attributable to the family members was included in the amount of the member-related head lump sum - however, the relationships between the number of members and the number of family members had developed differently between the regions since then, without this the flat rate per capita would have been corrected accordingly by the end of 2008. The total upper remuneration limit was calculated by multiplying the per capita amount by the number of members of a health insurance company in the federal state concerned.
Medical area
With the amendments to the Statutory Health Insurance Competition Enhancement Act on January 1, 2009, the head lump sum was abolished in the medical area and replaced by a morbidity-oriented allocation of financial resources to the health insurance funds, which no longer relates to members but to insured persons.
Dental area
In the dental area, the total upper remuneration limit is still calculated according to the flat rate per capita, depending on the KZV area and health insurance per member or per insured person. The respective head lump sum is multiplied by the number of members of a health insurance company or by the number of people insured by a health insurance company. When switching from membership to insured persons, a volume-neutral conversion must be ensured.
Total remuneration in contract dental care
With the Statutory Health Insurance Supply Structure Act of 2011, the strict orientation towards the development of the basic wage bill has been abandoned in contract dental care . In addition to the development of the basic wage bill, a number of other criteria must be taken into account as well as the GLS, which are specified by the newly formulated Section 85 (3) SGB V:
"In the contractual dental care, the contracting parties to the overall contract agree on changes to the total remuneration, taking into account the number and structure of the insured, the development of morbidity, the cost and supply structure, the working time required for the contractual dental activity and the type and scope of the dental services, insofar as they are based on a change in the statutory or statutory scope of services. When agreeing changes to the total remuneration, the principle of stable contribution rates ( Section 71 ) with regard to the volume of expenditure for the total of the contract dental services to be remunerated without dentures must be taken into account in addition to the criteria according to sentence 1. "
In this way, the payment of the dental fees at the agreed point value in the budgeted areas should be ensured in the future, without there being any fee reductions due to the use of the fee distribution standard.
criticism
The budgeting of health services is highly controversial. For the health insurances, in the form applicable until 2009, it had the effect that the expenditure in this sector was based on the general wage development and thus remained calculable for the health insurances. The amount of the head lump sum did not follow the demographic development, the change in morbidity, the medical progress or the development of the number of doctors, but was limited by law to the increase in the basic wage bill (GLS). In other words, it did not follow demand, but rather a non-relevant parameter that grew less rapidly (primacy of contribution rate stability ). See the development of the basic wage total according to the rate of change according to Section 71 (3) SGB V compared to the inflation rate. Because the amount of medically performed services rose annually faster than the head lump sums limited by the link to the basic wage development, the medical fees per service fell over many years ( floating point value ). With the Statutory Health Insurance Competition Enhancement Act of 2007, the basic wage amount-based growth in total remuneration paid by the health insurance companies to the statutory health insurance associations has been replaced by an orientation towards the development of the morbidity of the insured, as measured by diagnoses and demographic parameters been.
Web links
Individual evidence
- ↑ Fee distribution standard of the Association of Statutory Health Insurance Physicians in Bavaria ( Memento of the original from September 10, 2012 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.
- ↑ Fee distribution standard of the Bavarian Association of Statutory Health Insurance Dentists ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ “Flat rate per capita” ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. , Lexicon Health Policy , DAK . November 29, 2006.
