So far, no “positive supply effects” can be proven for the majority of digital health applications, as can be seen from the balance sheet report of the Association of Statutory Health Insurance Funds (GKV-Spitzenverband). “DiGA started the supply with a lot of early praise. But so far they have not lived up to expectations. Even after more than two years, the health apps are still in their infancy,” says Stefanie Stoff-Ahnis, board member at the National Association of Statutory Health Insurance Funds.
Accordingly, two-thirds of the digital health applications are only provisionally included in the directory – this is also possible without a sufficient evaluation of their effectiveness. Only those DiGAs that are listed in the directory of the Federal Office for Drugs and Medical Devices (BfArM) can be prescribed. The prerequisite for inclusion in the directory is that the manufacturer can demonstrate various properties such as security, functionality, quality, interoperability, data protection and positive supply effects.
Permanent admission can take place after 24 months in the course of negotiations with the health insurance companies. The manufacturers have to prove the effectiveness of the app. “The consistently high rate of DiGA on trial shows, however, that it often remains unclear what the offers really bring,” says Stoff-Ahnis.
Arbitrary price increases in the first DiGA year
Digital health applications can be prescribed by doctors as well as psychotherapists for about two years. The sometimes criticized high costs for the “apps on prescription” are borne by the health insurance companies. “Remarkably, the currently highest prices are all for test DiGA and are between 599 euros and 952 euros for one quarter. There is therefore no causal connection between the level of the prices on the one hand and the proven benefit on the other hand,” says the report . It is even the case that there were significant price increases even for digital health applications, the trial period of which was extended due to lack of effectiveness in the first year.
Price development of the DiGA
Three test DiGAs have been completely removed from the DiGA directory, three other applications were not included in the DiGA directory with all their functions by the Federal Office for Drugs and Medical Devices (BfArM). Nevertheless, both the canceled and the not fully approved health applications had to be financed by the statutory health insurance companies – although no improvement in care for the insured could be proven. In addition, the National Association of Statutory Health Insurance Funds criticizes that the manufacturers can set the prices for the DiGA “within the first year in the DiGA directory – as they wish”. In the meantime, manufacturer prices have increased “again by 20 percent” compared to the previous year and would thus be far above prices for comparable digital applications.
Health insurance companies see potential and demand clear rules
Nevertheless, Stoff-Ahnis sees “great potential” since DiGA “can support patients in recognizing or monitoring diseases.” Therefore, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) demands that the legislature “quickly put a stop to the apparently arbitrary pricing in the first year of inclusion in the DiGA directory”. In contrast to securing patient care, the “business promotion with contribution money” is not the task of the health insurance companies – especially since DiGA are currently only a supplement to the existing care.
It is necessary to only include DiGA with “clear medical benefits” in the directory. In addition, the National Association of Statutory Health Insurance Funds demands that negotiated prices may not be subsequently increased and that both doctors and the National Association of Statutory Health Insurance Funds are included in the approval process.
Criticism also from Bavaria
Only recently, an expert opinion commissioned by the Bavarian Association of Statutory Health Insurance Physicians (KVB) showed that proof of the medical benefits of DiGA was often not provided due to the lack of scientific depth of the effectiveness studies. For this reason, the KVB had also called on politicians to listen to the scientific findings and to improve the inclusion criteria for the health apps in the DiGA directory of the Federal Institute for Drugs and Medical Devices (BfArM). The KVB also complained that health insurance contributions were wasted on digital applications of questionable benefit – these contributions were urgently needed elsewhere in the healthcare system.
(mack)
