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Implications of the EU Patients’ Rights Directive in Cross-Border Healthcare on the German Sickness Fund System

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Health Care Provision and Patient Mobility

Part of the book series: Developments in Health Economics and Public Policy ((HEPP,volume 12))

Abstract

We examine the implications of the EU directive on the application of patients’ rights in cross-border healthcare on the German sickness fund system. Since Germany implemented most requirements of the directive already in 2004, we first review Germany’s experience with EU cross-border healthcare. We then focus on the possible effects of increased EU cross-border healthcare. While this gives patients more choice, the German sickness fund system faces a number of challenges. EU cross-border care may undermine efforts to keep healthcare expenditure under control. Cross-border care can also increase inequality of access. Furthermore, promoting cross-border care can be a means for sickness funds to attract good risks. We discuss these challenges and point out possible policy responses.

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Notes

  1. 1.

    The German risk-adjustment scheme differentiates capitations according to 40 age and gender groups, 6 reduced earning capacity groups and 155 hierarchic morbidity groups which are based on 80 diseases.

  2. 2.

    See Chambers et al. (2010, p. 3).

  3. 3.

    Regulation (EEC) No 1408/71 of the Council of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community.

  4. 4.

    Gesetz zur Modernisierung der gesetzlichen Krankenversicherung dated 14 November 2003 | Bundesgesetzblatt 2003 Part 1 No. 55.

  5. 5.

    In the following "EU member States" or "EU cross-border care" also includes these European countries.

  6. 6.

    Social Code Book V, Sect. 140e.

  7. 7.

    Social Code Book V, Sect.  13 para. 4–6.

  8. 8.

    Regulation (EC) No 883/2004 of the European Parliament and of the Council on the coordination of social security systems of 29 April 2004.

  9. 9.

    See Federal Ministry of Health in Germany (2013).

  10. 10.

    For cross-border care in the Meuse-Rhine eurogio based on regulation No. 1408/71, the additional administrative cost was estimated to be 5 % (Grunwald and Smit 1999).

  11. 11.

    See Wagner et al. (2011), p. 14.

  12. 12.

    To some extent, other sickness funds have also contracted with foreign providers. See Nebling and Schemken (2006) for further examples.

  13. 13.

    The sickness fund “AOK Rheinland Hamburg” .

  14. 14.

    See Wagner et al. (2011, 2013).

  15. 15.

    Nevertheless, waiting times exist in Germany. Roll et al. (2012) find that SHI patients have to wait on average 16 days to get an appointment with a specialist. Privately insured patients, by contrast, only have to wait 7 days on average. They also found that increased income had a negative effect on waiting time, pointing to an income gradient in the access to health care.

  16. 16.

    See Zweifel et al. (2009), Sect. 5.5 for a discussion of types of rationing of health care services.

  17. 17.

    The German DRG system is managed by InEK (Institut für das Entgeltsystem im Krankenhaus). Information can be obtained on its website http://www.g-drg.de.

  18. 18.

    See footnote 16 for evidence for unequal access in Germany.

  19. 19.

    See Baeten (2011, p. 265).

  20. 20.

    Explicit rationing may also exclude a treatment from the benefit package of the public health care system. In this case, however, cross-border care is not reimbursed either. Nevertheless, those with more financial means have an advantage because they can obtain this treatment either at home or abroad.

  21. 21.

    Breyer (2013) argues that it would be desirable to limit implicit rationing and to move towards explicit rationing.

  22. 22.

    This would be an instance of indirect risk selection where insurers use the design of the benefit package to attract favorable risks (see Zweifel et al. 2009, Chap. 7).

References

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Author information

Authors and Affiliations

  1. Universität Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354, Hamburg, Germany

    Mathias Kifmann

  2. Wissenschaftliches Institut der Techniker Krankenkasse für Nutzen und Effizienz im Gesundheitswesen (WINEG), (Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care), Bramfelder Straße 140, 22305, Hamburg, Germany

    Caroline Wagner

Authors
  1. Mathias Kifmann
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Correspondence to Mathias Kifmann .

Editor information

Editors and Affiliations

  1. Department of Economics and Management, University of Brescia, Brescia, Italy

    Rosella Levaggi

  2. Department of Economics, University of Genoa, Genova, Italy

    Marcello Montefiori

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Kifmann, M., Wagner, C. (2014). Implications of the EU Patients’ Rights Directive in Cross-Border Healthcare on the German Sickness Fund System. In: Levaggi, R., Montefiori, M. (eds) Health Care Provision and Patient Mobility. Developments in Health Economics and Public Policy, vol 12. Springer, Milano. https://doi.org/10.1007/978-88-470-5480-6_3

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