OR in Health Care Management at Karlsruher Institut für Technologie

Flashcards and summaries for OR in Health Care Management at the Karlsruher Institut für Technologie

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Study with flashcards and summaries for the course OR in Health Care Management at the Karlsruher Institut für Technologie

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What are the 4 basic principles of the german health system?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What types of healthcare are there?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What characteristics has the German health insurance?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What are the characteristics of private health insurance?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What characteristics does the statutory health insurance have?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What characteristics does the long term care have?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What are the characteristics of health insurers?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

How does the remuneration for registered physicians work?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

How can the allowed amount of money per quarter be calculated?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

How does the remuneration of private health insurance work?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What criticism would you give the German Health Care System?

Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

What opportunities are there to improve the GHCS?

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Exemplary flashcards for OR in Health Care Management at the Karlsruher Institut für Technologie on StudySmarter:

OR in Health Care Management

What are the 4 basic principles of the german health system?

- Obligation to insure

- Contribution-based financing

- Solidarity principle

- Self-administration 

OR in Health Care Management

What types of healthcare are there?

- Ambulatory care

- Stationary care

- Rehabilitation

- Long term care (Pflege)

OR in Health Care Management

What characteristics has the German health insurance?

• Funding: Statutory (SGB V) and private health insurances

• Full cover insurance for all necessary expenses

• Benefits: 

- Ambulant and stationary medical attention

- Mediation

- Sick-pay

OR in Health Care Management

What are the characteristics of private health insurance?

• People:

- Civil servants

- Self employed people

- People that exceed the upper income limit

• Insurance rate based on individual risk

• Offers complementary insurances (dental care)

OR in Health Care Management

What characteristics does the statutory health insurance have?

• People: Everyone that is not privately insured

• Main legal basis: SGB V

• Fixed contribution (not dependant on individual risk)

OR in Health Care Management

What characteristics does the long term care have?

• Funding: public and private

• Partial insurance

• Benefits depend on care level

• Possible benefits:

- Care allowance

- Ambulant nursing service

- Nursing home

OR in Health Care Management

What are the characteristics of health insurers?

• Freedom of choice for patients

• Obligation to contract

• Principle of benefits in kind:

- All necessary expenses are paid by health fund

- In contrast to reimbursement of cost principle

• No capital reserve allowed

OR in Health Care Management

How does the remuneration for registered physicians work?

• Compensation carried out by the KVs through the remuneration
distribution scale

• For each quarter year the physician has a fixed amount of money to exploit

• Basis for the remuneration is the uniform rating scale

which defines points for services, the value of a point is not fixed but can vary from quarter to quarter

• If the physician works more than allowed by this amount, he or she gets
his or her share of the leftover money from the KV for his or her region

OR in Health Care Management

How can the allowed amount of money per quarter be calculated?

budget = number of cases*case value*age factor



- case value = total amount of money for one group of physicians/ total number of cases treated by those physicians


- Case value further and further diminishes if the physician exceeds the
average amount of cases per quarter of his or her group by 150%, 170% and 200%, respectively

OR in Health Care Management

How does the remuneration of private health insurance work?

• Billing according to scale of fees for physicians

• Bill is send to the privately insured patient, patient has to settle the cost transfer with his or her insurer

• In general physicians apply the regular maximum rate
(Regelhöchstsatz) of 2.3 times the basic fee

• Physicians can offer individual health services

OR in Health Care Management

What criticism would you give the German Health Care System?

• Costs are increasing faster than the GNP due to aging society, trend to defensive medicine

• Increased cost are shifted to consumer

• High provider density

• High number of medical treatments

• Care is highly fragmented

OR in Health Care Management

What opportunities are there to improve the GHCS?

• Focus on maximizing outcome (patient value) for patients instead of minimizing costs

• Integration of treatments, build treatments chains connecting ambulant care, acute care and rehab working together to maximize patient value

• Build Integrated Practice Units

• Limit service spectra of providers

• Measuring patient value for every (common) disease and provider

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