Reimbursement Systems in Germany

Selective Contracts / Integrated Care

DRG and EBM Catalogue

The German healthcare system has two comprehensive Reimbursement systems: one is the DRG-Catalogue in Hospitals, the other is the EBM-Catalogue for the outpatient sector. These catalogues value the methods done at a patient, i. e. all diagnostics and therapeutical interventions.
In the private sector, there is a further catalogue, the honorary table for physicians (GOÄ)

These catalogues are final. There are several approaches for new methods to be included in one of the catalogue and thereby obtain a reimbursement value.

Due to the strong regulation of the German healthcare system and in particular due to the strict separation of hospital and outpatient care, the lawmakers in Germany created another instrument to give patients access to methods which are not part of the catalogues. This instrument is called selective contracts.

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What are selective contracts

In a selective contract, one or more medical provider (physicians, doctors offices or hospitals) negotiate with one or more health insurance the payment of a specific treatment or diagnostics, which will be paid for all patients in this health insurance.

Selective contracts are a relative „fast“ track into the German healthcare system, especially if the method is positioned at the boundary between hospital and out-patient care, or if the method is creating special economic benefits for the health insurance or if the method is completely new to the out-patient sector.

Selective contracts negotiation

The negotiation of selective contracts is complex. A vigorous and complete preparation is necessary. Economic and medical advantages need to be found and clearly explained for the negotiating partners. Equally important is the selection of the service providers and health insurances for the initial negotiations.

Moreover, any selective contract should always be seen in context of a broader market access strategy to align on mid-term goals. For example, negotiating an open contract with the possibility to allow other service providers and health insurances to enter the contract is enlarging the potential market.

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What are selective contracts

Kalms Consulting has been part of numerous negotiations and executions of selective contracts and possesses the right amount of experience to embed the element of a selective contract into a market access strategy. This ensures that this vital instrument is used at the exact right time.

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