Innovation in European healthcare – what can Sweden learn? - LIF

Central Changes in the German healthcare System
2011/12
• Health care reform of 2010 (Act for Sustainable and Socially Balanced
Financing of Statutory Health Insurance) was particularly dedicated to
reorganise the financing of the health system
– From January 2011 onwards, the income-related contribution rate is fixed at 15.5% by law
– Future over-proportional expenditure rises will be financed through premiums (Zusatzbeiträge)
– The premium is not income-related and has to be imposed by the respective Statutory health
insurance funds (SHI-funds), which are not able to cover their costs through the funds allocated by
the health care fund system (income-related contributions and subsidies by state)
– The basic idea of financing future health expenditure increases through premiums is such to foster
competition among SHI-funds
• The Act on the Reform of the Market for Medicinal Products (Gesetz zur
Neuordnung des Arzneimittelmarktes – AMNOG)
– Starting 2011, manufacturers are required to submit evidence of the added benefit for patients as
soon as they bring a product with new active ingredients to market
– The Joint Federal Committee decides if and what added benefit a new medicinal product has to offer
and under what circumstances it may be prescribed for reimbursement by the statutory health
insurance funds
– A maximum reimbursement rate will be fixed for medicinal products without an added benefit
– If this is not possible owing to a lack of other products with comparable pharmacological and
therapeutical properties, the manufacturer will agree on a reimbursement price with the statutory
health insurance that may not exceed the costs of the comparable therapy
– In the case of drugs that do have an added benefit, the GKV-Spitzenverband and the specific
pharmaceutical company then negotiates the reimbursement price
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