Risk classes and profiles
At the beginning of 2009, the former risk adjustment (RSA) will be replaced by morbidity-oriented RSA. This "Morbi-RSA" allows directly for the health condition of the insurant, e.g. with the help of stationary diagnoses and drug prescriptions. This arranges for an equitable competition oriented towards higher quality and efficiency in health care.
The procedure planned for Morbi-RSA no longer subdivides the insurants according to demographic criteria, the health condition is directly taken into account. Therefore the diseases of insurants have to be classified considering diagnoses and drug prescriptions.
Scientists surveyed all in all 18 methods for classifying diseases on behalf of the German Government, testing their fitness for Morbi-RSA. In their expertise they advise the american model "RxGroups+IPHCC". This system detects bonuses for morbidity criteria, drug prescriptions, stationary diagnoses, the status of reduction in earning capacity, and for age and sex.
The risk adjustment among the statutory health insurance funds (Risikostrukturausgleich in der gesetzlichen Krankenversicherung (RSA)) exists since 1994. Its aim is to prevent single health insurance companies from procuring advantages in competition by courting mainly youthful, healthy, and well-earning insurants.
In 2002, the legislator started a reform in risk adjustment to emend aberrations. The money shall definitely arrive where it is urgently needed to supply ill persons. An adjustment is aimed at that orientates itself by the actual diseases of the insurants - a morbidity-oriented RSA.
As from 2009, the "Morbi-RSA" shall finally guarantee that health insurance companies' competition is mainly on the quality of health supply.
History of risk adjustment
-
1992
Health care political agreement at Lahnstein: Federal government (CDU/CSU/FDP) and opposition prepare the ground for an increase in competition among the health care companies with the Gesundheitsstrukturgesetz. This law contains the introduction of free choice in health insurance companies and of a compulsory health insurance funds-wide risk adjustment (Risikostrukturausgleich (RSA)). - 1994
The RSA is initially introduced in general health insurance (without pensioners' health insurance). -
1995
The RSA is extended to the whole of compulsory health insurance companies. It replaces the inefficient expenses adjustment in pensioners' health insurance. -
1998
The law for financial strengthening of compulsory health insurance companies dictates a nationwide undivided balancing of financial power as from 2000. -
1999
With the approximation of laws for compulsory health insurance companies the Bundestag enacts the introduction of a complete risk adjustment across Germany by the end of 2007. - 2001
The legislator anchors the Morbi-RSA in the Code of Social Law. It is supposed to replace the formerly effective RSA. -
2002
Anticipating the Morbi-RSA, insurants with chronic diseases are accounted for separately in RSA if they inscribed for an accredited Disease Management Program (DMP). Respecting extra-ordinary expensive cases, a risk pool is installed covering all compulsory health insurance companies. -
2004
An expertise on behalf of the Federal Ministry of Health proposes a classification process for the Morbi-RSA. The connection with DMP and the risk pool shall be omitted then. - 2007
complete expertise advisory council disease choice (Bekanntgabe.pdf (German)) - ... 2009
The Morbi-RSA gets started and encourages sensible competition in quality and effectiveness of supply.
Further information:
- DRGs (Diagnosis Related Groups) for ambulant diabetology (an expert in diabetes
gives a book review (German))
- patient classification and risk profile analyses with Type-2-diabetics in specialized surgeries
- DRGs for ambulant diabetology, overview and return coupon