In , people were employed in pharmaceutical-producing companies . in the Pharmaceutical Price Ordinance ( Arzneimittelpreisverordnung). Seit sinkt die Zahl der Apotheken in Deutschland. Filialstruktur 05 . in der Arzneimittelpreisverordnung leicht angepasst. Index ( = ). wird in Deutschland durch die Arzneimittelpreisverordnung reguliert. and debt crisis, in particular in the second half of and

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Nursing insurance encompasses and organizes the tasks of the arzneimittelpeisverordnung and nursing arzneimittelpreizverordnung. In larger clinic networks, a board of directors generally manages the enterprise as a whole. Under German law, medicine is defined as materials and preparations of materials intended to cure, alleviate, prevent or diagnose diseases, ailments, physical injury or other physical complaints when applied to or in the human or animal body. Joining the SHI scheme, as opposed to the private system, is obligatory for individuals, whose income is below a legally specified amount income threshold in This includes negotiating contracts and remuneration packages with the state health insurance associations.

Municipalities, as relatively autonomous regional authorities with a guaranteed right to local self-government, enforce the legislation governing healthcare professions, the distribution of foodstuffs and medical products, contagious disease prevention and control and health education and counseling, with the public health offices implementing the various associated measures [ 157910 ] Fig.

The contracts negotiated by the association are binding for all SHI physicians. The insuree chooses the service provider and meets the incurred costs, which are later reimbursed by the insurance 20009 based arzneimigtelpreisverordnung the individual contract, either in full or in part.

The German healthcare system

Igl G, Welti F. While hospital physicians usually carry out the hospital treatment, general practitioners, if SHI-approved and with special authorization from the association of SHI physicians, can also treat patients on an inpatient basis—a provision that is limited to hospitals or hospital capacity also authorized for this purpose. Under certain conditions, hospitals can also treat patients on an outpatient basis.

This coverage is not permitted to cost more than the highest SHI premium and must be guaranteed by the private health insurance companies without individual risk assessment contractual obligation. The hospital funding law Krankenhausfinanzierungsgesetz, KHG defines hospitals as institutions for the diagnosis, curing or alleviation of diseases, ailments or physical injury and the performance of obstetrics by physician or nurses, in which the patients can be provided with room and board.

Private households pay deductibles and healthcare expenses such as over-the-counter medicines and services not covered by health insurance. An applicant must consent to the assessment and has to meet certain criteria to qualify for nursing care.

Arzneimittel-Festbeträge – GKV-Spitzenverband

Primary and secondary diagnoses, and the medical services corresponding to the diagnoses, comprise the most important distinguishing criteria. The level of these reimbursements depends on the individual insurance contract. Published online Dec Each hospital has physician, nursing and business administration teams, which are headed by a medical director, director of nursing, business director, respectively, who together comprise the hospital management.

For billing of private insurees, the applicable SHI fee schedule is taken as a starting point, and this amount can then be multiplied by a factor of up to 3.


Once the service atzneimittelpreisverordnung contract has been concluded, the insurers remunerate arzneimittelpreisverodrnung directly. For instance, the hospitals have to a be under the continual medical management of physicians, b have sufficient diagnostic and therapeutic capabilities to meet the terms of the hospital provision contract, c work according to scientifically recognized methods, d which can be applied by around-the-clock medical, nursing, support and technical staff, e to diagnose, cure, arrest and alleviate illness or provide obstetrics, primarily through physician and nursing care, f and which can provide patients with room and board.

The SHI physician must be a member of the relevant association of SHI physicians, and as such, must adhere to arzneimitgelpreisverordnung guidelines.

Ambulatory medical treatment in Germany Almost all outpatient medical treatment in Germany is carried out by registered physicians. For example, the social nursing insurance company remunerates the nursing services and pays the nursing allowance in cases of long-term care, the statutory health insurance company covers home nursing and arzneimittelpreisverordnubg assistance, public funding covers social welfare services and investment funding at state level, while private households cover all other costs.

Health premium increases are arzneimittlepreisverordnung only permitted, but also in fact prescribed by law, if expenses increase and can no longer be met by the SHI scheme. Pharmacies are divided into public i. Additionally, the medical associations enforce compliance with professional duties and form commissions that address various issues, including a mediation commission, expert commissions for medical malpractice and review boards to evaluate research proposals.

Please review our privacy policy. SHI arzneimtitelpreisverordnung receive the healthcare services as benefits-in-kind Sachleistungsprinzipwhich are provided by third parties e. For example, the Federal Arzneimittelpreivserordnung Committee G-BAon which physicians, dentists, hospitals, health insurers and patients are represented, has significant influence on which services are provided by the statutory health insurers and under which conditions.

To meet these requirements, the SHI funds have to provide the following services: Regardless of whether a nursing allowance or non-cash services are provided, persons requiring care are entitled to the provision of nursing and technical aids e. Hospital medical treatment in Germany The hospital funding law Krankenhausfinanzierungsgesetz, KHG defines hospitals as institutions for the diagnosis, curing or alleviation of diseases, ailments or physical injury and the performance of obstetrics by physician or nurses, arzneimittelpriesverordnung which the patients can be provided with room and board.

Both the state and federal associations are financed by member contributions, which are deducted by the associations for each Arzneimittslpreisverordnung physician from the lump sum compensation paid by the health insurers [ 127910 ].

For this reason, one goal pursued by the nursing insurance system is encouraging relatives and neighbors to provide the nursing care.

Only specially authorized hospital physicians are permitted to carry out such ambulatory treatment and the authorization is granted by the approval committee of the applicable association of SHI physicians for a limited, renewable term. Basic principles of social rights are used as the framework for ensuring social security in cases of illness, and must be followed by both the health insurance companies and health service providers.

The premiums are subject to the same income thresholds as for statutory health insurance and family members are also insured for free.


Women Men 1 Live births according to place of birthMental and behavioral disorders due to alcohol2 Heart failureLive births according to place of birth3 Malignant neoplasm of the breast [mammary]Angina pectoris4 CholelithiasisHeart failure5 Essential primary hypertensionHernia inguinalis6 Gonarthrosis [knee osteoarthritis]Chronic ischemic heart disease7 StrokeAcute myocardial infarction arzneimittelpreisveorrdnung, 8 Femur fractureMalignant neoplasm of lung and bronchus9 Perineal tear during birthCerebral injury10 Atrial flutter and fibrillationAtrial flutter and fibrillationThis inpatient treatment is remunerated from the overall compensation package for outpatient medical treatment, while the hospital expenses are charged to the patient or health insurance company in a separate billing procedure.

It is an important economic area and, with its large workforce of approximately 4. Specifically, the state must ensure sufficient, needs-based ambulatory and inpatient medical treatment, in qualitative and quantitative terms, as arznejmittelpreisverordnung as guarantee the provision of medicine. Sincepsychotherapists can also apply for the status of SHI-approved physicians, if they are members of the applicable association of statutory health insurance physicians and participate razneimittelpreisverordnung the SHI fee distribution system see below.

The aim of this article was to give an overview about the German healthcare system and gain an understanding of its complexity and principles of organization.

To prevent the insurance premiums from increasing too steeply with age and the associated higher expenses, the private insurers charge younger members higher contribution rate than necessary for their age and condition of health aging provision.


If the existing provisions do not meet the requirements, additional hospitals are included in the needs assessment. Only in extremely serious diseases and under strict conditions can non-prescription medicines be prescribed for coverage by the statutory health insurance company. If the review board determines that the applicant indeed requires nursing, the expert evaluator makes recommendations as to the level of nursing required, as well as the type and extent of measures necessary to reverse, lessen the need for nursing care or prevent the need from becoming greater.

Even though some states delegate the service guarantee arzneimittelpreisverodnung to municipalities, the responsibility for adequate hospital care remains that of the state in the final instance. The 17 state pharmacy associations are statutory corporations that represent professional policy interests, support the state authorities in the monitoring of medicine safety and quality and together comprise the federal pharmacy association.

However, this right only extends to medicines that are, firstly, only available on prescription and, secondly, not expressly excluded in SHI service catalogue. Ambulatory nursing facilities include welfare centers with a multitude of different, cooperating professions under one roof nursing staff, social workers, occupational therapists, family arzneimirtelpreisverordnung and private nursing care services usually owned by individuals.

Almost all outpatient medical treatment in Germany is carried out by registered physicians.

Received Oct 19; Accepted Nov If higher prices are demanded e. In contrast, prescription drugs may only be sold in pharmacies.