The Perspective of the Private Health Insurance in Germany for Health Economic Evaluations: Sense and Realization

At first this paper discusses under which conditions a health economic evaluation from the perspective of the Private Health Insurance (PHI) seems reasonable. Subsequent, a systematic overview of relevant resource use as well as its valuation from the perspective of the PHI is given. This includes all relevant cost domains from ambulatory and inpatient care as well as a detailed description of relevant data resulting from drug usage. For prescriptions the legal framework (e.g., reference pricing) is applied to list all relevant co-payments or discounts (e.g., for pharmaceutical companies) which have to be considered in patented as well as off-patent drugs. For ambulatory services the medical fee schedule should be considered. Regarding inpatient stays, general hospital services as well as treatment by chief physician and special accommodation have to be taken into account. As a result, for the first time, a pragmatic as well as a practical approach is presented to value resource usage within the German health care system in future studies from the perspective of the private health insurance.