Pharmaceutical Benefit Management: Möglichkeiten des Einsatzes in der Bundesrepublik Deutschland
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Inhaltsangabe: Einleitung: Seit ungefähr zwanzig Jahren explodieren die Gesundheitsausgaben - zumindest vermittelt der intensive Gebrauch der Metapher einer Kostenexplosion im Gesundheitswesen einen solchen Eindruck. Zwar scheint eine derartige Dramatik bei genauerer Betrachtung der Ausgabenentwicklung als Anteil am Bruttosozialprodukt sowohl in zeitlicher Entwicklung als auch im internationalen Vergleich übertrieben, und die Finanzierungsprobleme der Gesetzlichen Krankenversicherung (GKV) sind nicht nur auf die Ausgabenentwicklung zurückzuführen (ARBEITSGRUPPE PUBLIC HEALTH 1995). Dennoch besteht angesichts der Finanzierungslücken der GKV unbestrittener Handlungsbedarf Aufgrund der besonders starken Abhängigkeit von demographischen Faktoren wird die Bedeutung des Arzneimittelbereiches weiter wachsen. Um hier Handlungsspielräume zu erhalten, sind Ma nahmen mit dem Ziel einer rationaleren Arzneimittelversorgung unerlä lich. Gang der Untersuchung: Der Fokus der Arbeit liegt nicht primär auf einer Kostenkontrolle als Ziel - dies könnte mit einer Globalbudgetierung ebenso erreicht werden - sondern auf Fragen der Verbesserung der Mikroqualität der Versorgung, also einer Bewegung in Richtung der Kurve effizienter Behandlungsmöglichkeiten. Entsprechend der Zielsetzungen des unter Ressourcenknappheit operierenden Gesundheitssystems für die Arzneimittelversorgung (rationale Arzneimitteltherapie und Wirtschaftlichkeit der Versorgung) soll untersucht werden, ob die Übertragung von Steuerungsinstrumenten der Arzneimittelversorgung aus dem amerikanischen Gesundheitssystem eine für die Gesetzliche Krankenversicherung positive Veränderung leisten kann. Dabei geht es nicht um die Bestimmung eines optimalen Niveaus der Gesundheitsausgaben. Die politische Begrenzung der Gesamtausgaben, und damit Ressourcenknappheit, wird vielmehr als Datum angenommen. Im Rahmen dieser Arbeit soll dargestellt werden, welche Ma nahmen im Bereich der Arzneimittelversorgung bisher eingesetzt wurden, um
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Rich Dad Poor Dad: What the Rich Teach Their Kids about Money That the Poor and Middle Class Do Not!
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