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Title of Journal: J Public Health

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Abbravation: Journal of Public Health

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Springer-Verlag

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10.1007/s00712-010-0156-x

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1613-2238

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Reforming Germany’s risk structure equalization sc

Authors: Dirk Göpffarth
Publish Date: 2005/07/13
Volume: 13, Issue: 5, Pages: 248-256
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Abstract

In 2002 the German Bundestag enacted a major reform of the risk structure equalization scheme RSA between sickness funds This reform consisted of two shortterm measures the “risk pool” as stoploss reinsurance for sickness funds and the introduction of financial incentives for disease management programs In the medium term the sociodemographic risk adjusters are to be complemented by morbiditybased categories The shortterm measures are evaluated in this paper and the arguments for the mediumterm measure reviewedSelective mobility is detected as a problem of open enrolment and incomplete risk adjustment Using routine data from Germany’s RSA scheme the development of case mixes and expenditures of sickness funds with different growth rates were compared Risk pool and disease management programmes were evaluated using the results of the 2003 annual procedure of the RSA scheme Predictive ratios were calculated for certain types of sickness fundsThe introduction of a directly morbiditybased system remains an important measure to ensure competition between sickness funds The suggestions of an expert group commissioned by the Ministry of Health are a good basis for the further development but incentive concerns regarding the use of pharmacy data have to be addressed

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