“As the central lobby of statutory health insurance, we shape the outline conditions for healthcare in Germany. Our activities are focussed on the health of the 70 million insured.” Dr. Doris Pfeiffer, Chair of the Board of the National Association of Statutory Health Insurance Funds.
With one voice for the insured of statutory health insurance
The National Association of Statutory Health Insurance Funds is the central association of the health insurance funds at federal and European/ international level in accordance with section 217 a of Book V of the German Social Code (SGB V). All the statutory health insurance funds are members. It represents the interests of statutory health insurance at federal and European/ international level and shapes the outline conditions for intensive competition for quality and economic efficiency in healthcare in Germany.
The contracts concluded by the National Association of Statutory Health Insurance Funds, and its other resolutions, apply to all health insurance funds and their associations at subnational level, and hence to virtually all the 70 million individuals who have statutory health insurance. The National Association of Statutory Health Insurance Funds supports the health insurance funds and their subnational associations in fulfilling their tasks and representing their interests. For instance, it helps them to develop and standardise the electronic exchange of data within statutory health insurance.
The National Association of Statutory Health Insurance Funds is a public-law corporation. It is headed by a full-time Board comprising three members which represents the National Association of Statutory Health Insurance Funds both in and out of court. The Board is elected by the Administrative Council, which consists of a total of 52 representatives of insured persons and employers from the Allgemeine Ortskrankenkassen (Local Health Insurance Funds) (AOK), the Ersatzkassen (Substitute Funds), the Betriebskrankenkassen (Company Health Insurance Funds) (BKK), the Innungskrankenkassen (Guild Health Insurance funds) (IKK), the Knappschaft (Miners' Insurance Institution) and the Sozialversicherung für Landwirtschaft, Forsten und Gartenbau (Agricultural Health Insurance Funds). The Administrative Council decides on matters of fundamental impact and takes the strategic decisions in the Association’s area of responsibilities.
Streamlining tasks
This is an overview of some of its responsibilities:
- to conclude framework contracts and remuneration agreements for in-patient, out-patient and dental care
- to support the health insurance funds and their subnational associations in carrying out their tasks
- to represent the interests of statutory health insurance at federal level in joint self-government with the health care providers (e.g. in the Federal Joint Committee) and vis-à-vis the Federal Ministry of Health
- to represent the interests at EU level, for example in the context of opinions on medical devices or value-added tax legislation, data protection, patient mobility, quality of health care
- to decide on fundamental technical and legal questions of the contribution and reporting procedure in social insurance
- to set reference prices for medicines and therapeutic appliances, as well as maximum amounts for medicines
- to define requirements for remuneration negotiations and medicine agreements at Land level
- to contribute to the design of telematics in the healthcare system
- to define principles for prevention, self-help and rehabilitation
The National Association of Statutory Health Insurance Funds also acts as the National Association of Long-Term Care Funds.
In addition, it is the Medical Advisory Service of the National Association of Statutory Health Insurance Funds at federal level. The German Liaison Agency Health Insurance – International (DVKA) ist a part of the organisational structure of the the National Association of Statutory Health Insurance Funds.
All tasks not prescribed by law with which the health insurance funds are able to distinguish themselves in competition with one another are in principle within the latitude of the insurance funds. They can also transfer them to their fund-specific association or to an enterprise. This includes for instance discount contracts with the pharmaceuticals industry or special contracts with general practitioners.