Reimbursement system In Germany is usually categorized into different types. Mainly for intra hospital use and for ambulatory purposes. In both cases they have different decision makers and approval authorities. In this chapter we clearly explaining the types of organizations associated with the procurement and regulations.
Medical Practice Equipment (“Praxisbedarf”): – Praxisbedarf includes, for example, all necessary basic hardware (e.g. waiting room chairs) and technical equipment (e.g. ECG, ultrasound) of a medical practice; it is not patient-related. Praxisbedarf must be procured and paid for by the practitioner himself and is ultimately income-financed.
Medical Practice Supplies (“Sprechstundenbedarf”): – This refers to means that in their nature are intended for use on more than one patient within the scope of medical services. These include, among others
· Dressings and suture material (gauze bandages, swabs)
· Means of (local) anesthesia
· Disinfectants for use on the patient
· Reagents and quick tests
· Diagnostic and therapeutic means (e.g. plaster, disposable infusion sets)
· Drugs for emergency cases and instant use
Each KV district has a so-called Sprechstundenbedarf agreement in place detailing which products are billable as Medical Practice Supplies.
Hilfsmittel (Medical Aids and Appliances): – are prostheses, orthopedic gear, hearing aids or other products that serve to compensate or to prevent handicaps or to assist therapy. They include, among other items:
· Walking sticks
· Wheel chairs
All prescribing Hilfsmittel are listed in the Hilfsmittel index (positive list) and, if prescribed by a physician, are reimbursed by the patient’s health insurance fund.
The GKV-SV is responsible for compiling and maintaining the Hilfsmittel index as well as for defining reference prices for the Hilfsmittel. These prices cover both the actual costs for the Hilfsmittel and the associated service – the reference price for a bladder catheter, for instance, also includes the service of placing the catheter. The provision of services is subject to quality standards and falls within the responsibility of specially trained personnel (typically nursing staff). In Germany, services are mainly provided by so-called homecare companies specializing in the distribution and supply of Hilfsmittel and, where necessary, provision of instructions as to their use. The health care providers maintain agreements with these companies, that is, patients may not choose care providers freely. Manufacturers can file a written application with the GKV-SV to have the new product included. GKV-SV will forward the applications to medical and nursing experts for a medical and technical evaluation.
Individual Health Care Services (“Individuelle Gesundheitsleistungen”, IGeL) : – These are services that a doctor offers to statutory sickness fund members which are not billable to the insurance fund, i.e. the costs are to be borne by the patient. For the most part, IGeL refers to preventive and service-based medicine. IGeL have been criticized repeatedly over whether the offered services are actually necessary and reasonable.
Doctor’s Fee Schedule (“Gebührenordnung für Ärzte”, GOÄ) : – The GOÄ is a catalog for billing services provided to so-called private patients. In the broadest sense, the description of services in this catalog is comparable to the Uniform Evaluation Benchmark (EBM), although the services are more extensive and have a higher value. Doctors can therefore charge higher amounts. The services are typically charged directly to the patient. Such patients are usually covered by a private health insurance with which to file the doctor’s bill for reimbursement.