Germany's Federal Joint Committee

Over the next few weeks leading up to my departure for Germany, I’ll be discussing the topics I plan on exploring, along with some brief background on each one.  My purpose is to solidify my own thoughts on these issues and, perhaps, draw some insights from people who visit this blog.

In Germany, the various levels of government have virtually no role in the direct delivery of health care. A large degree of regulation is delegated to self-governing associations and provider associations. The most important body is the Federal Joint Committee, created in 2004 as a public health organization authorized to make binding regulations growing out of health reform bills passed by lawmakers, along with routine decisions regarding healthcare.  The Committee has wide-ranging regulatory power to determine the services to be covered by sickness (insurance) funds and to set quality measures for providers. To the extent possible, their coverage decisions are based on evidence from health technology assessments and comparative-effectiveness reviews.  The Committee is composed of physicians, psychotherapists, dentists, pharmacists, hospitals, sickness funds and patients (although patients do not have a right to vote).

I will hopefully be meeting with members of the Committee and/or their staff when I visit Berlin, which will give me an opportunity to learn much more.  What I like at first blush is the German emphasis on making decisions about healthcare based on evidence and results rather than political expedience and ideology.  That’s not to say that there aren’t politics involved; certainly there are, and I plan to speak with politicians across the political spectrum to better ascertain how government interacts with the healthcare system.  But the evidence I see from my research is that the German system, much more than ours in the United States, is focused on making public health and access to care a national priority. The first question in the U.S. over any healthcare initiative is often whether or not conservatives will see it as government overreach or whether liberals will see it as ignoring vulnerable classes. In Germany , the first questions seems to be whether the initiative will achieve a desired public health outcome that is measurable.  The Committee appears to be a valuable structure for this framing by putting daylight between the politicians and the healthcare professionals. Of course, it is possible that these professionals will have their judgments clouded by some of the same factors that influence legislators, which would make the system much less innovative than it could otherwise be.  This is something I look forward to examining.