Dr Norbert Schmidt Prize for Stefan Kästner

Digital health applications (DiGA), which provide support for conditions such as diabetes, depression, back pain or weight loss, have been available on prescription in Germany since 2019. Until now, health insurance providers have paid out as soon as an application was downloaded. This is set to change: In future, remuneration will be based more heavily on whether an application delivers demonstrable benefits in practice. Dr Stefan Kästner investigated how this might work in his dissertation. For his outstanding work, he has been awarded the Dr Norbert Schmidt Prize, worth 10,000 euros.

The award was presented at Fulda University of Applied Sciences by the prize’s founder, the Fulda-based radiologist Dr Norbert Schmidt. “Rising expenditure in the healthcare system and increasingly scarce funds from statutory health insurance providers make it necessary to assess digital health applications more closely in terms of whether they are actually effective,” said Dr Schmidt. The prize winner’s work provides sound basics for this, along with concrete recommendations for health insurance providers, manufacturers and policymakers.

The University President, Professor Dr Karim Khakzar, highlighted the very high overall standard of the dissertations submitted and praised the academic and practical quality of the prize winner’s work: “This year, we are honouring a thesis which, in addition to its high academic quality, also contributes to an ongoing process of health policy reform.”

The thesis’s initial supervisor, Professor Dr Stefan Greß, highlighted the award winner’s connection to Fulda University of Applied Sciences: “I am delighted that Mr Kästner has returned to the university following his university studies in Health Economics and Health Policy in Fulda and his Master’s degree in Switzerland. It was a great pleasure for me to provide supervision for his thesis.”

Payment based on success – but how?

The topic focuses on the current reform process regarding the remuneration for digital health applications (DiGA): the legislator is calling for a more performance-based remuneration system. At least 20 per cent of the costs are to be linked to success criteria. However, DiGA manufacturers and health insurance providers have so far been unable to agree on what exactly counts as success – such as regular use, completed modules or improved health indicators.

This is where Dr Stefan Kästner came in: he identified potential building blocks for success-based payment and investigated which of these are acceptable and feasible in practice. In doing so, he also took into account legal requirements and the realities of healthcare provision.

Interviews and expert panels

Methodologically, the dissertation draws on a mix of qualitative and quantitative approaches: First, Dr Kästner conducted interviews with experts to identify different perspectives and design options. Subsequently, patients, doctors, psychotherapists and specialists from health insurance providers and manufacturers assessed these proposals in a two-stage survey procedure. This revealed where there is broad consensus and which points are contentious. Finally, the award winner synthesised the results and derived recommendations relevant to both practice and policy.

A signal for patient-centred health care

Dr Kästner sees the reform of DiGA remuneration as an opportunity for the healthcare system as a whole: “If remuneration is based more strongly on evidence of benefit, those applications that provide the greatest benefit to patients will be rewarded more highly in future. In this way, competition to improve the quality of digital care can be stimulated. Patients’ well-being could become a key factor in triggering remuneration in future. The findings of the research thus contribute to making medical care more patient-centred.”

The Dr Norbert Schmidt Prize was awarded for the fifth time. It honours outstanding dissertations produced at Fulda University of Applied Sciences. Seven candidates had applied for the award. Dr Eva Bauer, Dr Monika Schak and Dr Muriel Cathérine Wenzel received a certificate as recognition for their work. Their theses had been assessed with more than 80 out of 100 marks.