Personal responsibility for health - Developments under the German healthcare reform 2007

European Journal of Health Law

Volumn 14, Issue 3, 2007, Pages 241-250

  Schmidt, Harald ^a  

^a UK Human Genetics Commission   (United Kingdom)

Author keywords

Ethics; Germany; Gesetz zur St rkung des Wettbewerbs in der gesetzlichen Krankenversicherung; GKV WSG; Health responsibility; Healthcare reform; Personal responsibility; Solidarity

Indexed keywords

CANCER PATIENT; CHRONIC PATIENT; COOPERATION; ETHICS; GERMANY; HEALTH CARE POLICY; HEALTH INSURANCE; LAW; LIFESTYLE; RESPONSIBILITY; REVIEW; REWARD;

CHRONIC DISEASE; COST SHARING; GERMANY; HEALTH BEHAVIOR; HEALTH CARE REFORM; HEALTH EXPENDITURES; HUMANS; INSURANCE BENEFITS; LIFE STYLE; MANAGED COMPETITION; NATIONAL HEALTH PROGRAMS; PRIMARY PREVENTION; RISK-TAKING; SELF CARE;

EID: 35848956838     PISSN: 09290273     EISSN: 15718093     Source Type: Journal    
DOI: 10.1163/092902707X240602     Document Type: Review

References (22)

1. E. Steinbrook, "Imposing Personal Responsibility for Health," N. Engl J. Med 2006; 355; 8: 753-756.
2. G. Bishop, A.C. Brodkey, "Personal Responsibility and Physician Responsibility - West Virginia's Medicaid Plan," N. Engl J. Med 2006; 355; 8: 756-758.
3. British Medical Association (BMA), "A rational way forward for the NHS in England - A discussion paper outlining an alternative approach to health reform," May 2007, BMA: London, available from: http://www.bma.org.uk/ap. nsf/AttachmentsByTitle/PDFrationalwayforward/$FILE/rationalwayforward. pdf (accessed 20 August 2007),
4. see also: H. Schmidt, Patient Charters and Health Responsibility, BMJ 2007 [forthcoming],
5. H. Schmidt, Health Responsibility, the Left and the Right, Hastings Center Bioethics Forum, July 6 2007, available from: http://www.bioethicsforum. org/personal-responsibility-health-care-Medicaid-Membership-Agreement.asp (accessed 20 August).
6. Only 13 of these have more than 1m contributing members. This paper concentrates on three of the four largest providers: Barmer Ersatzkasse (5,3m) Techniker Krankenkasse (3,8m), and Allgemeine Ortskrankenkasse/AOK Bayern (3,8m). The great total number of sickness funds is a reflection of the historical background of the German healthcare system: although the first comprehensive codification took place in 1883, unemployment, accident and health insurances have been provided since the 15th century, when many professions and trades had their specific schemes. This background is still reflected in the names of many insurance providers which suggest they are unions of, for example, rail workers, engineers, or sailors. Membership is, however, now generally open to people of all professions see: U. Weide, "Law and the German Universal Healthcare System: A Brief Contemporary Overview." German Law Journal [serial on internet]. Aug 2005; 6 (08): 1143-1171, available from: www.germanlawjournal.com/pdf/Vol06No08/PDF_Vol_06_No_08_1143- 1172_Developments_Weide.pdf (accessed 20 August 2007) .
7. See SGB V Article 25 and 65a - Note that the law also states that bonuses must not be funded through higher contributions, but through savings and rationalisations made through encouraging person to lead healthier lives. All statutory health-insurance scheme providers are required to report regularly, at least every three years, to the relevant authority (Bundesversicherungsamt) on the savings made. Where no savings are made, no bonuses may be paid.
8. Techniker Krankenkasse [homepage on the internet]. "TK Bonusprogramm," available from: http://www.tk-online.de/centaurus/ generator/tk-online.de/03_fit_and_well/07_bonusprogramm/100-praemien/ 06_gesundheit_genuss/apple_ipod.html (accessed 20 August 2007).
9. There are 31 measures, see: Techniker Krankenkasse [homepage on the internet]. "TK Bonusprogramme," available in English from:http://www.tk-online.de/centaurus/generator/tk-online.de/s07_english/ dossiers/01_lexicon/tk_bonus_programme/tk_bonus_programme.html (accessed 20 August 2007) .
10. Barmer [homepage on the internet]. "Beitrags-Bonus-Rechner Wie hoch ist Ihr Beitrag?" available from: https://www.barmer.de/barmer/web/Portale/ Versichertenportal/Leistungen_20und_20Beitr_C3_A4ge/ Beitr_C3_A4ge_20_26_20Beitragsrechner/Beitrag-Bonus-Rechner/Beitrags- Bonusrechner.html?appInstanceId=117495159491479&appView=userDataView& webflowTraceContainerToken=1174951594914376 (accessed 20 August 2007).
11. In 2006, average gross monthly earnings of salaried employees was 3510€ (3595€ in the west, 2679€ in the east), average gross monthly earnings of wage earners was 2582€ (2669€ in the west, 1994€ in the east), see: Federal Statistical Office Germany [Homepage on the internet]. "Wages and salaries, updated 6 Mar 2007, available from: http://www.destatis.de/indicators/d/lrverueb.htm (accessed 20 August 2007).
12. Programme "Erfolgsbonus für Gesundheitsbewusste," The qualifying data is as follows: Body-Mass-Index (BMI) BMI between 18,5 bis 25,0, blood pressure below 140 mmHg systolic and/or below 90 mmHg diastolic; fasting blood sugar below 6,1 mmol/l (110 mg/dl); total cholesterol below 200 mg/dl, ie 5,17 mmol/l. See: Barmer [homepage on the internet]. "Erfolgsbonus für Gesundheitsbewusste," available from: http://www.barmer.de/barmer/web/ Portale/Versichertenportal/Leistungen_20und_20Beitr_C3_A4ge/ Beitr_C3_A4ge_20_26_20Beitragsrechner/Wahltarife/Bonusangebote/ content_20ErfolgsbonusCID_70844.html (accessed 20 August 2007) .
13. Gemeinsamer Bundesausschuss, "Bekanntmachung des Gemeinsamen Bundesausschusses über die Befunde, die zugeordneten Regelversorgungsleistungen, für die Festzuschüsse nach den §§ 55, 56 des Fünften Buches Sozialgesetzbuch (SGB V) zu gewähren sind (Festzuschuss-Richtlinien in der Fassung vom 17. November 2006), sowie die Höhe der auf die Regelversorgung entfallenden Beträge nach § 57 Abs. 1 Satz 6 und Abs. 2 Satz 6 und 7 SGB V in den Abstaffelungen nach § 55 Abs. 1 Satz 2, 3 und 5 sowie Abs. 2 SGB V, gültig ab 1. Januar 2007," Dec 2006, BAnz. Nr. 232: 7239 [4 pages], available from: http://www3.kzbv.de/knachri.nsf/ 126e4da9af05d01541256a500057d8e7/51e5d19ef47532cec1256f4-20053742d/$FILE/ GBA_031104_Beschluss_A.pdf (accessed 20 August 2007).
14. e.balance - magazin für soziales [serial on the internet], "Bessere Grundversorgung für die Versicherten," Mar 2007; Nr 049 03/2007 [about 4 p.], available from: http://www.bundesregierung.de/Content/DE/ EMagazines/ebalance/049/sa-bessere-gesundheitsversorgung.html (accessed 20 August 2007).
15. A timetable is available from: Bundesministerium fur Gesundheit [homepage on the internet]. "Was kommt wann?" http://www.die-gesundheitsreform. de/gesundheitsreform/ueberblick/was_kommt_wann/index.html(accessed 20 August 2007).
16. For a critical discussion: Parens E. Enhancing Human Traits: Ethical and Social Implications, Hastings Center Studies in Ethics, 2nd ed. Washington: Georgetown University Press; 2000.
17. "Since insured persons who decided to have [tattoos, cosmetic surgery, piercings] voluntarily exposed themselves to health risks, it is not appropriate to cover costs for [treatment resulting from health complications] through the collectively contributed funds." [my translation] see: Bundesregierung, "Entwurf eines Gesetzes zur Stärkung des Wettbewerbs in der Gesetzlichen Krankenversicherung (GKV-Wettbewerbsstärkungsgesetz - GKV-WSG)," 25. Oktober 2006. Begründung; B. Besonderer Teil; p 300-301.
18. The programmes concern participation in: treatment programmes recommended by the insurer (Art. 63 SGB V); schemes that focus on GP-centred access to care (rather than self-selection of specialised physicians, Art 73b); using outpatient services from an agreed set of providers only (Art 73c); specially developed treatment schemes for chronically ill patients (Art 137f and 140, see also Art 62).
19. Techniker Krankenkasse [homepage on the internet], " Pressemitteilungen Politik," released 23 Mar 2007, available from: http://www.tk-online.de/centaurus/generator/tk-online.de/s03_presse-center/ 01_pressemitteilungen/02_politik/pm_070323_wahltarife.html (accessed 20 August 2007).
20. The commentary on Article 53 (8) SGB V in the draft law submitted by the Government to the upper House of Parliament (Bundesrat) explicitly states that "cross-financing" of bonuses through contributions from insured persons on different schemes is not permitted, as is increasing insurance contributions of those taking part in the scheme, see: Bundesregierung, "Entwurf eines Gesetzes zur Stärkung des Wettbewerbs in der Gesetzlichen Krankenversicherung (GKV-Wettbewerbsstärkungsgesetz - GKV-WSG)," 25. Oktober 2006. Begründung; B. Besonderer Teil; p 304.
21. Persons born before the cut-off dates may also qualify for the 1% rule. However a certificate enabling them to benefit from the 'chronically ill' status will only be issued by their physicians if they comply with relevant treatment schemes (such as Disease Management Programmes/DMPs).
22. Bundesregierung, "Entwurf eines Gesetzes zur Stärkung des Wettbewerbs in der Gesetzlichen Krankenversicherung (GKV- Wettbewerbsstärkungsgesetz - GKV-WSG)," 25. Oktober 2006. Begründung; B. Besonderer Teil; p 304.