[Comprehensive Care Centre and section 116b SGB V. Experiences from the point of view of the health insurance company]. / Comprehensive Care Center und section sign 116b SGB V. Erfahrungen aus der Sicht des Kostenträgers.

ABSTRACT

Through the GMG (modified law of health system) the section sign 116b "out-patients department" was newly introduced into the SGB V (5(th) social welfare legislation) in 2004. Thus, the health insurance companies had the possibility to come to an agreement with hospitals concerning rare illnesses such as haemophilia. On this basis a care agreement was agreed upon in 2005 between the University Hospital Eppendorf (Hamburg) and three big health insurance companies. The result leads to positive changes for all concerned The patients were offered an optimal care through the link to the CCC and this with an adequate compensation for the coagulation section for out-patients. As the therapy programme became more clarified, the communication between the parties involved became more constructive. With the law to strengthen competition (WSG) for the insurance companies, a change of section sign 116b of the SGB V (5(th) social welfare legislation) came into force in 2007. Thus the legal basis for the a. m. agreement was withdrawn. It is now the task of the a. m. parties to find a way to secure the advantages obtained through this agreement, to the benefit of the patients, the coagulation sections for out-patients and the cost bearers.