Federal Joint Committee (Germany)

The Federal Joint Committee (G -BA) is the highest body of the joint self-administration in the health sector in Germany. It is mandated by the legislature to decide legally binding in many areas over the entitlement of the solidarity of about 70 million statutory health insurance scheme in Germany people.

Legal basis

The legal basis for the Federal Joint Committee forms of § 91 of the Fifth Book of the Social Code ( SGB V), is introduced, which came into force on 1 January 2004 law on the modernization of the statutory health insurance ( GMG ).

The SGB V stipulates that benefits the statutory health insurance ( GKV) must be " sufficient, effective and economical ." They " must not exceed what is necessary " ( efficiency principle ). In addition, the law requires that the diagnostic or therapeutic benefits, the medical necessity and cost-effectiveness must be demonstrated by performance before they can be part of the SHI benefit package.

The G -BA fulfills its powers conferred by the legislature functions are essentially the fact that he decides policies or already updated existing policies. These guidelines are in ranking while below of laws ( under statutory standard character ), but are nonetheless legally binding on all statutory health insurance and actors in the SHI. They apply to the outpatient treatment of established physicians, dentists and dentists and psychotherapists, as well as treatment in hospitals and clinics.

His legal mandate and therefore its legitimation receives the G -BA by the Bundestag and the Bundesrat in Germany. The Federal Joint Committee is a separate legal entity under public law and is under the legal supervision of the Federal Ministry of Health (BMG ).

The G -BA is not a subordinate authority, but an organ of indirect State administration, on the path of delegation in recent years more and more sovereign, governmental tasks are delegated. The decisions of the G -BA must be submitted to the BMG for review. The review of the Ministry is limited to the legally correct adoption of decisions. A technical and substantive review by the Ministry is not provided by law. About the scope and limits of the possibilities of the Ministry to take substantive influence on the legal test is repeated in court, has been disputed.

Tasks and procedures

The Federal Joint Committee replaced with its construction so far five adjacent active committees:

• Federal Committee of Physicians and Health Insurance
• Federal Committee of Dentists and Sickness Funds
• Federal Committee on questions of psychotherapy
• Coordination Committee
• Committee hospital.

He meets a variety of decisions on issues of health care under the statutory health insurance. He is also responsible for quality assurance and quality management tasks. The Committee is supported by the Institute for Quality and Efficiency in Health Care ( IQWiG) appraisals. Its operation is stored in a business and of rules of procedure, which decides the Joint Federal Committee itself, but requires the approval or non-objection of the Federal Ministry of Health.

In particular, he has a general competence for the exclusion or limitation of services, if following the general state of medical knowledge of diagnostic or therapeutic benefits, the medical necessity or the economy are not detected. Other major tasks include the decision of guidelines that specify the individual services for contract doctors, hospitals, insurance and health insurance, for example in the areas of medical and dental treatment, early detection, demand planning, nursing home care and pharmaceuticals. The Committee has finally to decide on the admission of new examination and treatment methods for SHI and drug groups, can be fixed for the fixed amounts to be determined.

Thus, the G -BA has among others, the disease management programs (DMP ) in accordance with § 137f SGB V Guidelines for Diabetes Mellitus Type 1 and Type 2 diabetes mellitus, breast cancer and coronary heart disease as well as recommendations for Bronchial Asthma and Chronic Obstructive Pulmonary Disease adopted.

Composition

The Committee has 13 voting members.

5 representatives of the cost object (represented by the national sickness fund associations; since 1 July 2008 Central Federal Association of Health Insurance, now called Statutory Health Insurance Funds Association ) and 5 representatives of service providers ( represented by the physicians ' Confederation, the dentists' Confederation and the German Hospital Federation ).

In addition, there are three referees members, one of whom is Chairman of the Committee. Impartial Chairman is currently Josef Hecken. More Impartial members are Harald Deisler and Regina Klakow Franck. The above organizations must agree on the three officials, otherwise they shall be appointed by the Federal Ministry of Health. From the founding of the Federal Joint Committee from 2004 to 2012, Rainer Hess Impartial Chairman.

Even up to 5 general patient representatives and five thematic patient representatives and representatives take an advisory role in plenary and committee meetings, have a request, and the right to bring their vote before voting, but are not entitled to vote. They shall be designated by agreement between the relevant organizations after the patient involvement Regulation, ie the German Disability Council, the Federal Association of Patients points, the German Association self-help groups eV and the Consumer Federation eV. The associations which qualify for participation as a patient representative on the Federal Joint Committee are mentioned in § 2 of patient involvement Regulation ( PatBeteiligungsV ) ​​.

Reception

The G -BA has been accused of being an instrument of health insurance companies and policies to ration healthcare at the expense of patients.

Patients representative of the German AIDS Help, who took part in the deliberations of the G -BA for the transfer of diamorphine-assisted treatment in the standard care in 2010, reported a " rude tone - flanked by personal attacks." In their view, it seemed to the committee members a priority to go about enforcing their ideologically motivated rejection of this treatment, which had already become clear by the Bundestag in hearings about excessive requirements.