The need for medical devices (bandages, walking aids, wheelchairs, hospital beds and so on) in Germany is increasing. This is clearly substantiated by statistics from the German Association of Private Health Insurance (Verband der Privaten Krankenversicherung, PKV-Verband [PKV]). In the PKV’s statistical report from 2019, there was already a recognisable growth of 7.35 per cent per policyholder compared to the previous year, whereby the insurance benefits grew by only four per cent overall. Looking at the demographic development in Germany, an additional noticeable increase can be expected with the baby boomer generation. The percentage of medical devices in outpatient services is already 8.18 per cent of the total costs.

For the insurers, this continuous increase means that they either need more staff for processing the applications for medical devices or they have to design their processes to be more efficient.

In contrast to SHI, in private health insurance, making reimbursements for medical devices depends on the policy and the type of medical device. Smaller medical devices, such as bandages, do not require a cost estimate, but are instead reimbursed by the private health insurer as part of the usual settlement procedure if they are included in the policy. For larger medical devices, either reimbursements are made as lump sums from the catalogue or policy-dependent reimbursements are granted. These usually have to be applied for in advance. Depending on the diagnosis, special equipment/models are then also approved. After being approved, reimbursement is made the same way as it is for smaller medical devices. The policyholders obtain the medical device from the medical supply store, pay for it and submit the receipt to the private health insurer. All in all, it is a laborious, manual process that takes time.

The announcement of electronic care (eVO)

The German electronic prescription (elektronische Verordnung, eVO) for medical devices is to be considered analogous to the German ‘E-Rezept’ (e-prescription). Policyholders receive a code instead of a paper prescription and can use it to start the digital process. The rollout starts on 1 July 2024, then, as of 1 July 2026, the electronic prescription will be obligatory for medical device providers. The basis for the eVO is the German Digital Healthcare and Nursing Care Modernisation Act (Digitale-Versorgungs-und-Pflege-Modernisierungs-Gesetz, DVPMG) from May 2021. An end-to-end digital process must be linked to the prescription, otherwise the significance of it will be lost. In light of the increasing demand for medical devices, this is another reason for insurers to change the processes for providing medical devices at an early stage. Insurers now have the opportunity to implement a customer-centric approach that benefits everyone involved.

Three perspectives on the future of the medical device provision process

The future medical device provision process must be viewed from different perspectives. Advantages can be quickly seen from every angle.

adesso is developing the policyholder app for the medical device provision process, including a corresponding back end, and ensuring the integration of the private health insurance systems with the aid of the adesso in|sure health product family. The systems from HMM complement the technical components associated with the medical device provision process.

A two-day workshop in which we analyse your company’s current situation. We work with you to develop a medical device provision process for the future and tailor it to meet to your needs. Once we are done, we will happily prepare you an implementation offer.

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