German Health Care Terms

Arzneimittel – Pharmaceuticals

Arzneimittelmarktneuordnungsgesetz (AMNOG) – 2011 law that made the cost of new medicines dependent on the results of a cost-benefit analysis carried out by the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG).

Beitragssatz – The proportion of income paid by individuals to the Gesundheitsfonds. Set at 15.5 percent since 2011.

Belastungsgrenze – An upper limit on personal expenditures for health care items that are not fully covered by GKV, such as certain medications. Once this limit is reached, GKV pays further costs.

Festbetrage für Arzneimittel – Maximum price that GKV insurers are allowed to pay for medication. Additional costs must be paid by the patient. Intended to increase pressure on suppliers to produce low-cost medications.

Gesundheitsfonds – A central fund that receives income payments from the insured, then distributes them to the GKV insurers.

Gemeinsamer Bundessausschus – A board of health care industry representatives with the legal authority to determine the services provided within the GKV.

Gesetzliche Krankenkassen ­– Non-profit insurance agencies legally authorized to sell GKV. The Gesetzliche Krankenkassen are financed indirectly and uniformly by the insured through the Gesundheitsfonds and directly by the insured through additional payments. Because they are required to offer the same level of minimum services, these providers differentiate themselves by means of price competition or, traditionally, by profession.

Gesetzliche Krankenversicherung (GKV, Statutory Health Insurance) – Uniform health insurance regulated by the Gemeinsamer Bundessausschus, a council of industry representatives. All Germans earning under a certain amount must purchase GKV, which may only be provided by legally authorized Gesetzliche Krankenkassen

GKV-Finanzierungsgesetz – A 2011 law that revised GKV finances. Read more.

Hausarztversorgung – The use of a primary physician as a gatekeeper for further treatment. Unlike in the United States, German primary physicians generally do not play a gatekeeper role. Insured individuals who take advantage of Hausarztversorgung are eligible to pay lower fees.

Kosten-Nutzen-Bewertung – Cost-benefit analyses carried out on new medications by the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) to determine price.

Solidaritätsprinzip – The solidarity principle, an underlying principle of the German GKV system that determines what individuals pay into the system according to their income level while receiving equal insurance coverage.

Versicherungspflicht – The requirement that all individuals in Germany hold insurance, written into law in 2009. The equivalent of the Affordable Care Act’s Minimum Coverage Requirement.

Versicherungspflichtgrenze – The level of income above which individuals may opt out of GKV and purchase private insurance independently. Currently set at around €44,550.

Zusatzbeitrag – Additional funds that GKV insurers may charge the insured if required by high costs. Allowing the charging of additional funds is intended to encourage competition between GKV insurers to keep costs down.

AICGS

www.aicgs.org
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