The German Health Care System
and the Federal Joint Committee
(G-BA)
Norbert Schmacke
FJC/ University of Bremen
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
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?)
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 (>
esspecially for hospitals and pharmaceuticals)
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.
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
…
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
“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
Co-operation with the Institute for Quality and
Efficiency in the Healthcare System (IQWiG)
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
Thank you for your attention!
Contact: schmacke@uni-bremen.de