Reimbursement of New Health Technologies in a DRG-System

Abstract

Rationale: A prospective reimbursement system based on Diagnosis Related Groups (DRGs) has been recently introduced in several European countries for acute inpatient treatment, e.g. in Germany in 2003. To enable the application of new health technologies a special reimbursement process has been developed for those technologies. Objectives: To present how new technologies can be reimbursed under DRG-conditions, using Germany as a case example. Methods: Material of the official German DRG-Institute (InEK - Institut fur das Entgeltsystem im Krankenhaus gGmbH), the German hospital society (DKG - Deutsche Krankenhausgesellschaft) and the biggest German health insurance (AOK - Allgemeine Ortskrankenkasse) was screened manually and electronically. In addition, interviews with experts of those organisations were conducted. Results: New technologies causing higher costs for hospitals are not adequately compensated within the current G- (German) DRG-system. Since 2005, they can be reimbursed with a special add on (NUB - Neue Untersuchungs- und Behandlungsmethode). Each hospital has to apply for a NUB individually by the end of October at the InEK which decides by the end of December whether the respective hospital will get a NUB for one year. This decision is based on the submitted evidence on the medical effectiveness and economic impact of the new technology on the hospital. The NUB will not be granted if there is not enough medical or economic evidence or if the new technology does not lead to a specific increase of costs. The value of this threshold is only known by the InEK. The amount of the NUB depends on negotiations between the individual hospital and the sick funds and can differ between hospitals. When there is enough data of resource use and costs for the new technology the InEK will determine either (1) a national add on (Zusatzentgelt) which is applicable for all hospitals or (2) adjust the payments for the existing DRGs which include the new technology or (3) even create a new DRG. The number of NUBs substantially increased from 26 in 2005 to 54 in 2006 while the number of national add ons increased from 71 to 82 in the same time period indicating that the system enables the dissemination of technologies causing higher costs for the hospital. Conclusions: The G-DRG-system seems not to substantially hinder the introduction and adaptation of new technologies causing substantially higher costs for the hospital. However, there are no incentives to implement new technologies that are rather inexpensive for the hospital. Clearly, this problem should be addressed by the InEK.