Private health insurance, allowance payments for civil servants and private medical fee schedule

Karl Lauterbach has been the minister in the Federal Ministry of Health since December 2021, and in his first year he mainly dealt with Corona. Now the focus should be on fundamental issues of health policy such as hospital structural reform and the avoidance of structural breaks in medical care. However, some important fundamental issues in outpatient care and the future of private health insurance, subsidies and (doctors' fee schedule) GOÄ are still unprocessed. GOÄ (Gebührenordnung für Ärzte) is a billing basis for medical services provided by private physicians, which is mainly used in medical practices for PKV patients. The German Medical Association (BÄK) has submitted its own GOÄ proposal with prices to Health Minister Lauterbach, which has not yet been finally consented. The PKV association and the state aid are not currently pursuing this proposal. Volume 33 presents a political economy analysis that also includes SHI-accredited health care. In the chapter "Health policy recommendations for action", several measures of an EBM (and GOÄ) amendment are proposed. These include far-reaching changes in the remuneration structure of SHI-accredited physicians. The proposals aim to create a transparent and fairer system in the outpatient sector so that SHI patients can better assess the value of their treatment.