This paper will describe obstacles to the introduction of medical inventions and discoveries within the German healthcare system, discuss their causes, and advance proposals for how the existing problems could be solved. This dissertation is fundamentally about healthcare economics, and references theoretical approaches regarding the economics of institutions. It will investigate the development of and interactions between organisational errors that result from the behaviour of the many stakeholders in the healthcare market, impeding innovations in the sense of the successful marketing of new products. The theoretical discussion of the subject matter and the results of the investigation will be supplemented by two case studies, relating to acupuncture and negative pressure wound therapy. Innovations in the healthcare system can be described in terms of a conflict of objectives between the desire to help the patient and the principle of optimal economic efficiency: not every medical invention is effective (e.g. the discussion regarding antiviral therapy for hepatitis C); and effective drugs, therapies and processes do not need to be innovative (e.g. the treatment of hepatitis C with pegylated interferons/ribavirin). Only those medical inventions that balance out this conflict of objectives without losing the connection to medical research are competitive, allow reliable planning, and deserve the name of innovation. The aforementioned conflict of objectives is specifically established by the behaviour of two institutions: on the one hand, the testing authorities award the CE marking on the basis of the German Medical Products Act, thus licensing a medical technology product for the market; on the other hand, the statutory health insurers decide whether to include such a product in their reimbursement catalogue. It does not typically present a problem for the predominantly small companies in the field of medical technology to obtain the CE marking, but inclusion in the statutory health insurers’ reimbursement catalogue often does not take place. The statutory health insurers commission extensive studies in order to review the cost-benefit ratio, and potentially to investigate alternatives. The post-licensing phase and the negotiations with the manufacturers end when the reimbursement value is determined. Whether a medical innovation is genuinely innovative or not is therefore decided not directly by the market, but in protracted, bureaucratically complex and non-transparent processes (e.g. the ‘AMNOG’ Pharmaceutical Market Reorganisation Act licensing process), which are influenced by a range of lobbying interests. The transaction costs for an invention are artificially inflated, and innovation potential, which could make the German healthcare system more competitive internationally, often remains unexploited. An improvement of the innovation culture in the German healthcare system can only be achieved by unravelling the interwoven economic, scientific and political interests. Modern innovation management, which in any case needs to take market uncertainties into account, requires transparent testing procedures. Essentially, it is a question of finding a compromise between avoiding conflicts of interests and the necessary degree of cooperation. On this basis, it would become possible to both aspire to and achieve the streamlining of test procedures, thus ensuring their cost effectiveness. Healthcare policy needs to have a vested interest in ensuring that transaction costs during the introduction of inventions are returned to the healthcare system; this is not yet currently the case.
|School:||Universitaet Bayreuth (Germany)|
|Source:||DAI-C 81/4(E), Dissertation Abstracts International|
|Subjects:||Organization Theory, Economics, Health care management|
|Keywords:||Health care economics|
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