title: Disease management and health care reforms in Germany - does more competition lead to less solidarity?
abstract: Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment). To balance competition and solidarity, a risk compensation scheme (RCS) was implemented two years prior to open enrollment. Since then, balancing competition and solidarity has been a key feature of all consecutive health care reforms. The implementation of disease management programs in the statutory health insurance (SHI) served the dual purpose to promote quality of care and to foster competition. Preliminary experiences suggest, that the aligning of disease management programs with a RCS can greatly aid its implementation and benefit solidarity and competition.
authors.affiliation: Institute of Health Economic and Clinical Epidemiology, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne, Germany. Stephanie.Stock@medizin.uni-koeln.de
authors.forename: Stephanie Anja Katharina
authors.initials: SA
authors.lastname: Stock
authors.forename: Marcus
authors.initials: M
authors.lastname: Redaelli
authors.forename: Karl Wilhelm
authors.initials: KW
authors.lastname: Lauterbach
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D019468:Disease Management; D004465:Economic Competition; D005858:Germany; D018166:Health Care Reform