Die Perspektive der Gesetzlichen Krankenversicherung in der gesundheitsökonomischen Evaluation

The economic evaluation of health technologies from the perspective of the Statutory Health Insurance (SHI) gains increasing importance. But so far there is no systematic presentation of this perspective in the literature. The article at first develops the sickness funds perspective from the target system of SHI, which is distinguished into (1) a normative level, (2) a positive target system of each single sickness fund and (3) a positive target system of the collective SHI-system, in which the normative level is used as gauge. Subsequently the cost valuation of the main healthcare services from the viewpoint of sickness funds are derived from the target systems: (1) physician care, (2) pharmaceuticals, (3) medical remedies and ancillary equipment, (4) in-patient care, (5) rehabilitation care and (6) sick pay. Additionally alternative calculation schemes of healthcare costs from the perspective of the sickness funds are developed which account for different data access in health economic evaluation projects. Finally the SHI-perspective is compared to the societal perspective.