gms | German Medical Science

22nd Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

03.12. - 04.12.2015, Dresden

Morbidity Related Groups (MRG) and drug economic efficiency index – a new concept after the age of "Richtgrößen" benchmarks in Germany.

Meeting Abstract

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Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 22. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Dresden, 03.-04.12.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15gaa10

doi: 10.3205/15gaa10, urn:nbn:de:0183-15gaa108

Published: December 9, 2015

© 2015 Schuster.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background: Till 2016 the so called "Richtgrößen" benchmark had to be used by law as a measure of drug economic behaviour of doctors in the outpatient area. From 2017 on they should be replaced by local agreements between Statutory Health Insurance (SHI) and the Regional

Association of SHI-Accredited Physicians on the basis of GKV-VSG (GKV-Versorgungsstärkungsgesetz). The “Richtgrößen”-benchmark could include the morbidity structure very purely only by excluding special drugs and doctors or patients and using the insurance status.

Materials and Methods: In the inpatient area Diagnoses Related Groups (DRG) are used to classify patients to groups especially with respect to their diagnoses.The groups are determined by a grouper using complex algorithm and definitions. The DRG groups are associated with monetary values by calculations of the InEK using real treatment costs of certain hospitals.

We use drug prescription data with respect to § 301 SGB V of regional Statutory Health Insurances in 2014. For each patient per physician and quarter we consider a Morbidity Related Group (MRG). As a first step in this direction we consider the group of drugs at ATC (Anatomical Therapeutic Chemical) 4 level with the largest costs. This group is related to the morbidity of the considered patient. In analogy to the DRG system we can expand the ATC 4 value by a severity degree (e.g. A – F) in dependence of multimorbidity, age and treatment intensity if there are extended differences between subgroups. For all patients within a Morbidity Related Group (MRG) we determine the mean cost of all drugs, not only those in the considered ATC group. Using this we get a budget value of the MRG. The calculations should be done separately for different physician groups.

For a certain amount of all patients (e.g. 50%), not only those with drug prescriptions, ordered by decreasing drug costs, we can calculate the budged sum associated to their MRG. In dependence of the physician group we consider the ratio of all costs and the cost of those 50% of the patients and enlarge the calculated budget value of a physician by this ratio. If the whole real drug cost do not exceed the MRG-budget value, the physician has a 100% drug economic efficiency index. In the other case the index is determined by the ratio of the MRG-budget and real costs and lies between 0% and 100%.

Results: In contrast to the “Richtgrößen” benchmark the regional morbidity structure is integrated in the MRG model and the drug economic efficiency index calculated on this basis. The physician has large flexibility in order to reach a certain goal for the considered index. Goals may be defined by regional benchmark analysis, e.g. the best third of the physicians of a physician group determine the goal value. Changes of the market structure and guidelines automatically includes in the yearly actualisation of the calculations. The calculations are manipulation resistant. Activities in order to reduce multimedication improve the drug economic efficiency index although multimorbidity as a morbidity risk may be included in the model.

For the general practitioners 50% the costs are covered by 8 MRG in calculations without severity degrees. These top positions are B01A (antitrombotic agents), N02A (opioids), A10A (insulines and analogues), R03A (adrenergics, inhalants), A10B (blood glucose lowering drugs, excl. insulins), V04C (other diagnostic agents), C09D (angiotensin II antagonists , combinations) and A02B (drugs for peptic ulcer and gastro-oesophageal reflux disease).

Conclusion: The proposed index is not limited to special group of drugs. Therefore the whole prescribing behaviour of the practitioners is affected in the direction of morbidity adjusted efficiency. One should analyse problem areas of MRG and the drug economic efficiency index after a test period of one year in order to improve the system. Thereby a more complex definition of the MRG using a complex MRG grouper is an option.


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