Point value
The point value is the monetary value of an evaluation point in the fee schedule of the statutory health insurance (GKV) and in the private fee schedule for doctors (GOÄ) and dentists (GOZ). The value of every medical service is determined by an assigned number of points (evaluation number).
Statutory health insurance fees
The fee schedule of the GKV for the medical sector is the uniform assessment standard (EBM) and for the dental sector the assessment standard for dental services (BEMA). The fee for the individual medical or dental service results from the multiplication of the assessment number in points by the point value in euros.
The evaluation standards EBM and BEMA according to § 87 SGB V determine the content of the billable services and their value-related relationship, expressed in points. Dental services that are not included in the BEMA are assessed according to the schedule of fees of the fee schedule for doctors (GOÄ) dated November 12, 1982 in the currently valid version. To determine the evaluation number, 1 BEMA point is to be set for 9 GOÄ points.
The point value is renegotiated annually between the health insurance companies and the Association of Statutory Health Insurance Physicians (KV) or the Association of Statutory Health Insurance Dentists (KZV).
Primarily due to budgeting , but also due to other factors (e.g. degression ), the agreed point value and thus the fixed fee remains only a theoretical figure and in practice is sometimes significantly below.
Medical area
Since 2009, the evaluation committee has set a so-called national orientation point value. The Extended Evaluation Committee set this benchmark value for 2009 at 3.5001 cents and for 2010, 2011 and 2012 at 3.5048 cents. As of October 1, 2013, the orientation value (previously: 3.5363 cents) and the imputed point value (previously: 5.11 cents) were increased to 10 cents. The increase - that was a condition of the health insurance companies - was neutral in terms of expenditure, that is, the prices in the Uniform Assessment Standard (EBM) did not change due to the adjustment alone. So that the multiplication of the respective number of points by 10 cents resulted in the same price as before with 3.5363 cents, the number of points, the evaluation of the performance, was reduced in the EBM. The orientation value was increased to 10.4361 cents from January 1, 2016. The KVs have the option of agreeing surcharges on top of the benchmark value with the health insurance companies for services worthy of support and in undersupplied planning areas.
| year | increase | cent |
|---|---|---|
| 2020 | +1.52% | 10.9871 |
| 2019 | +1.58% | 10.8226 |
| 2018 | +1.18% | 10.6543 |
| 2017 | + 0.9% | 10.5300 |
| 2016 | +1.6% | 10.4361 |
| 2015 | +1.4% | 10.2718 |
| 2014 | +1.3% | 10.1300 |
| 2013 | + 0.9% | 10.0000 |
| 2012 | - | |
| 2011 | - | |
| 2010 | - |
The point values of the EBM cannot be compared with the point values of the BEMA because they are based on different evaluation numbers.
Dental area
In the dental field, the nationwide point value for dentures for 2019 is 0.9297 EUR. For the other services, the point value varies depending on the health insurance company and the federal state. However, this point value will be standardized, weighted and weighted , under the health insurance companies in accordance with the Statutory Health Insurance Supply Structure Act from 2013 - individually in each federal state .
Private fee schedules
In the federal fee schedule for dentists (Bugo-Z), which came into force in 1965, the individual services were valued in D-Marks, which led to the calculation amount with a multiplier (1-6 times). During the volume-neutral changeover to a new fee schedule in 1988, the individual services were reassessed. Since then, the fee schedule for doctors (GOÄ) and the fee schedule for dentists (GOZ) have provided the individual services with a rating number in points. The point value is set by the federal government (there ultimately by the Federal Ministry of Health (BMG)) with the consent of the Federal Council . The multiplication of the evaluation number in points by the point value and the rate of increase (1-3.5 times) results in the respective fee.
The point value of the GOÄ increased by 3.6% in 25 years (1988-2013):
- the GOÄ point value was
- as of January 1, 1983 10 pfennigs,
- on July 1, 1988 11 pfennigs, and amounts to
- 11.4 pfennigs since January 1, 1996 or 5.82873 cents since the changeover to the euro on January 1, 1999.
The point value of the GOZ has remained unchanged for 25 years (1988–2013):
- Since the GOZ came into force, the GOZ point value has been:
- 11 pfennigs as of January 1, 1988 or 5.62421 cents since the changeover to the euro on January 1, 1999.
In the same period (1988–2012) the average annual inflation rate in Germany was around 2%.
See also
Page references
swell
- tariff for doctors
- Schedule of fees for dentists
- National Association of Statutory Health Insurance Physicians
- National Association of Statutory Health Insurance Dentists
