Berlin: (hib/PK) The third report from the umbrella association of statutory health insurance (GKV) on the provision of digital health applications (DiGA) is available to the Bundestag as information (20/10549). With the inclusion of DiGA in the GKV service catalogue, a groundbreaking step has been taken in the further development of digital healthcare. Germany is an international pioneer with the “app on prescription”, according to the foreword to the report, which refers to the period from October 1, 2022 to September 30, 2023.
However, in view of the expectations and the great potential for care, the balance sheet is characterized by disillusionment, the foreword from the GKV board continues. Currently, DiGA is hardly embedded in existing care pathways. In addition, the benefits of DiGA are often unclear at the beginning. This means that doctors rarely prescribe DiGA. This can be attributed to the inadequate requirements of the approval process. Both the total number of DiGA and the evidence of benefits provided remain manageable.
In the first year of inclusion in the GKV service catalog, the price for a DiGA is set by the manufacturer, independent of the benefit receipt. With an average of almost 530 euros, these prices have increased again compared to the previous year. The results of the report reinforced the impression that arbitrary price setting in the first year of GKV approval, particularly for trial DiGA, leads to enormous disproportionate and inappropriateness compared to the remuneration of other GKV services and the remuneration of DiGA with a proven benefit.
According to the information, a further problem arises when reimbursement claims from health insurance companies lead to liquidity problems and insolvencies of manufacturers. In such cases, there would be high financial defaults for the GKV. According to the GKV, it would be conceivable to initially use the average price of all DiGA prices that have already been negotiated from the 13th month of DiGA admission until a remuneration amount has been agreed. It is positive that more and more DiGAs are proving their benefits in the course of their testing. However, there is still a significant need for adjustment.
From the first inclusion of a DiGA in the GKV directory in September 2020 to September 30, 2023, a total of around 374,000 DiGA were used by insured persons, as the report shows. The GKV spent 113 million euros on this. Compared to the previous year, utilization and expenditure have more than doubled.