Voting behaviour in AMNOG benefit assessments

Abstract

The study examines the voting behaviour in the G-BA in AMNOG benefit assessments since 2011, showing on the one hand that most decisions (93%) are passed unanimously. On the other hand, it is particularly striking that the National Association of Statutory Health Insurance Funds (GKV-SV) voted in favour of a lower classification of added benefit in 100% of the dissenting resolutions compared to the other benches. The result empirically illustrates a procedural conflict of interest at the GKV-SV and underpins the structural criticism regarding the governance deficits of the G-BA. Even in the unanimously adopted procedures, these deficits can lead to a systematic negative distortion of the benefit assessment. This cannot be verified due to a lack of documentation at the G-BA. Overall, the unity of the GKV-SV as regulator, referee and player in the AMNOG procedure should be scrutinised more closely. This also applies in particular to the evaluation of the more recent statutory interventions (guard rails and combination discounts), which are highly susceptible to conflicts of interest.