gms | German Medical Science

We examined the effects of the Law on Modernising Statutory Health Insurance (= GMG) on the pharmaceutical market for statutory and company health insurance. A comparison was made between actual savings and individual price structure effects (changes in price regulations for pharmaceuticals, rebates, as well as co-payments, and the change in compulsory payments for non-prescription pharmaceuticals) as well as changes in attitudes among doctors, the insured and the pharmaceutical industry.

Present prescription data of all German SHI-physicians from January 2003 to May 2005 have been analysed. On the one hand, we drew up a comparison between the actual figures from 2003 for pharmaceuticals and the 2003 figures which would have been valid under the GMG conditions. On the other hand, we analysed the actual effects and structural shifts based on the development concerning the regulation and turnover and compared them to the expected figures.

Due to changes in attitudes and evading strategies being applied by the insured (by getting prescriptions for medicine, remedies and aids in 2003 before the new legislation came into force), by doctors (for using non-prescription drugs as a substitute for ethical drugs for example by antihistaminic or anti-osteoporotic agents, prescriptions as „favours", the trend to prescribe larger packaging units), as well as by the pharmaceutical industry and the adjustments introduced in the GMG only being carried out with delays (passing of new structured reference price groups) the anticipated savings of approximately three billions EURO (corresponding to a reduction of 12%) will not be reached to the full extent. The derived projection for 2004 shows that by constant prescription behaviour savings of maximum 8% will be realized.

The applied method is suitable as an instrument for analysing the effects of structures and attitudes of those involved.

Initiator of Study: BKK Bundesverband

Conflict of interest: none