Health care reform 2007

On April 1, 2007, the "Act for the Enhancement of Competition in Statutory Health Insurance" (SHI Competition Enhancement Act) will become effective in Germany. This reform will result in several structural changes for the financing of the German health care system:

Beginning in 2009, the statutory health insurance funds will be financed through a so-called "health fund." It will be supported from the contributions of insured patients and employers and co-financing from tax revenues. In addition, the statutory health insurance funds may charge their insured patients an individual flat fee not to exceed 1% of their income.

Private health insurance will be maintained, but the insurance companies must offer a basic rate package whose service terms and extent will be comparable to those of statutory health insurance (SHI). This basic rate package can be selected by all people who are members of or are eligible for private health insurance. Acceptance into this basic health plan can not be refused by private health insurance companies (contracting obligation).

Two regulations in the field of pharmaceutical care affect the pharmaceutical companies in particular:

For the first time ever, a possibility is created for the head association of the statutory health insurance funds to stipulate maximum reimbursement amounts for patented pharmaceuticals based on a cost-benefits assessment. This also represents the first time that the benefits evaluation and cost-benefits assessment conducted by the Institute for Quality and Economy in the Health Care Sector (IQWiG) must comply with international standards of evidence-based medicine and health economics. Furthermore, the Institute must ensure transparency and the participation of experts, patients and the pharmaceutical industry. Pharmaceuticals with proven cost effectiveness or without a suitable therapeutic alternative are not subject to a maximum reimbursement amount.

In addition, a mandatory secondary opinion by specially qualified physicians will be introduced for the prescription of drugs with high annual therapy costs or a considerable risk potential.

These new regulations will contribute to an additional bureaucratization of the health care system, especially in the field of pharmaceutical care - quite a deviation from the greater competitive orientation mentioned in the title of the legislation. "The health care reform hasn't been subjected to a practical stress test yet, and I'm sure that many a theorist will be in for a surprise," said Cornelia Yzer, director-general of the German Association of Research-based Pharmaceutical Companies (VFA). "For innovative pharmaceuticals, the legislation provides new regulatory instruments with many unsettled implementation issues. This legislative actionism regarding patented drugs in particular is unnecessary, because out of every euro spent by statutory health insurance only 3.9 cents are spent on patented innovations."

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