1. The German Health Care System and the Federal Joint Committee (G-BA)
Dr. Tilo Mandry – Health – Made in Germany – Santiago de Chile

2. Basic principles of the German health care system
Germany has about 82 million inhabitants
72 million (50 million members) are covered by statutory health insurance (remaining are privately insured)
currently approx. 190 (+50) insurance companies
7 types of sickness funds
blue-collar workers = regional health insurance funds (AOK), or substitute funds (EK Arb) guild funds (IKK) or company-based sickness funds (BKK)
white-collar workers = substitute health insurance funds (EK Ang)
farmers‘, miners‘, sailors‘ funds

3. Basic principles of the German health care system II
today‘s characteristics:
share of premiums between employee and employer
self-administration / self-government
MoH sets general rules, details regulated by self- governing bodies
free choice of sickness-funds and providers
comprehensive benefit catalogue
opting out of statutory insurance above annual income of 49,000€ for three years in a row (one year in future?)
contribution rate:
0.5% for dentures to be covered by employees alone

4. Basic principles of the German health care system III
today‘s characteristics (cont.):
working solidarity principle, i.e.
no surcharge for age or risk
low salary = low payment
contributions for unemployed & welfare recipients paid by public funds
highly developed infrastructure, no waiting lists in hospitals
problems: aging society, innovations, costs (> especially for hospitals and pharmaceuticals)
contribution payment dependent of salary up to an annual ceiling (currently 46,800€, i.e. 3,900 per month)

5. The Federal Joint Committee (G-BA)
G-BA is
the main decision-making body in the German health care system,
authorised by law to issue legally binding directives - but not a subordinate authority
Legal Basis: Social Code (Book V)
established in the year 2004, but predecessor committees dating back to the 1920s,
represents physicians, hospitals, sickness funds and patients.

6. What does the G-BA do? The G-BA issues directives and guidelines.
It thus determines the benefit package for:
Ambulatory and hospital care
Dental care
Psychotherapy
Diagnostic and therapeutic procedures and interventions
Quality assurance
Disease management programmes for chronic diseases
Pharmaceuticals, Vaccines and Medical Devices …

7. What does the G-BA NOT do?
Contracts between single payers (e.g. sickness funds) and providers or manufacturers
Regulation of premiums
Risk adjustment among the sickness funds
Payment of doctors
Determination of the amount paid for procedures, interventions or pharmaceuticals
DRGs

8. “Who” is the G-BA? Health care providers
Federal association of office-based doctors
Federal hospitals’ associaton
Health care payers
Federal association of sickness funds
Representatives of sickness funds
Three Impartial Members
Patients’ representatives
Non-voting members

9. Co-operation with the Institute for Quality and Efficiency in the Healthcare System (IQWiG)

10. Discussion
G-BA decisions are under the legal supervision of the Ministry of Health
Procedure and decision about benefit assessments take a (too) long time, in some cases coverage of innovations are delayed
Discrepant regulation for coverage decisions for outpatient and hospital sector

11. ©Chris Schmidt - istockphoto
Thank you!