What are the key entities for health system governance?
Within the legal framework, the Federal Joint Committee has wide-ranging regulatory power to determine the
services to be covered by sickness funds and to set quality measures for providers (see below). To the extent
possible, their coverage decisions are based on evidence from health technology assessments and comparativeeffectiveness
reviews. The Federal Joint Committee is supported by the Institute for Quality and Efficiency
(IQWiG), a foundation legally charged with evaluating the cost-effectiveness of drugs with added therapeutic
benefits, and the Institute for Applied Quality Improvement and Research in Health Care (the AQUA Institute).
Since 2008, the Federal Joint Committee has had 13 voting members: five from the Federal Association of
Sickness Funds, two each from the Federal Association of Statutory Health Insurance Physicians and the
German Hospital Federation, one from the Federal Association of SHI Dentists, and three who are unaffiliated.
Five patient representatives have an advisory role but no vote in the committee.
The Federal Association of Sickness Funds works with the Federal Association of Statutory Health Insurance
Physicians and the German Hospital Federation to develop the ambulatory care fee schedule and the DRG catalogue,
respectively, which are then adopted by bilateral joint committees. To extend competition beyond these
jointly regulated issues, some purchasing powers have been handed over to the sickness funds, e.g., to contract
providers selectively within an integrated care contract or to negotiate rebates with pharmaceutical companies.