Aus der Deutschland

Some of the demerits of socialised medicine: There cannot be one fixed standard for all.This is from the lancet.


Physicians' groups in Berlin have slammed an aspect of the government's health reform which has left around 20% of doctors having to pay for their patients' medicine out of their own pocket, with some also facing fines for their prescribing practices.
The new Bonus-Penalty Ruling (Bonus-Malus-Regelung) placed even more pressure on doctors to spend less on medicine.

The Bonus-Penalty Ruling drew on the daily defined dosage (DDD) notion pioneered by WHO. Though WHO originally introduced DDD solely as a means to compare prescription demands in different countries, the Bonus-Penalty Ruling takes the notion of a DDD and attaches a fixed daily budget to it.
As a result doctors in Germany are now allowed to prescribe only a set daily dosage at a set daily rate.Under terms of the Bonus Penalty Ruling, set daily rates apply for drugs used to treat high blood pressure, depression, migraines, prostate illnesses, and osteoporosis. Drugs, for example, used to treat depression, migraines, and blood pressure are only allowed to cost 37 cents (around 25 pence) per day.
The potential benefit of the legislation for doctors is that if they spend less than their budget, their regional KV will award them with a form of “credit” allowing them to spend more on prescribing drugs thereafter. For this to happen all doctors within one regional KV must together spend less than a collective budget. If, however, this collective budget is exceeded, the individual doctors who spent less than their individual budget, go unrewarded.

Interestingly the WHO says that DDD system by itself is not suitable for guiding decisions about reimbursement, pricing and therapeutic substitution.