Preliminary analysis of short-term financial implications of a prevention bonus program: first results from the German Statutory Health Insurance.
OBJECTIVE
With the implementation of the Health Care Modernization Act in 2004 sickness funds in Germany were given the opportunity to award bonuses to their insured for health-promoting behavior. The aim of this study was to investigate the financial implications of a prevention bonus program from a sickness fund perspective.


METHODS
The investigation was designed as a controlled cohort study (matched pair study) comprising 70,429 members in each group. Matching criteria were sex, postal code, insurance status, and cost categories for health care utilization. Insured opted into the program on a voluntary basis. The program consisted of interventions featuring primary prevention, modest exercise and immunization. Differences in cost trends between the two groups were examined using the paired t-test.


RESULTS
A reduction in mean costs of 241.11 Euro per active member for the year 2005 (90% CI = 348.70, 133.52; p-value < 0.001) could be achieved in the intervention group compared to the control group. When costs for the implementation of the program and the bonus payments were taken into account, there was a saving of 97.14 Euro per active member for the year 2005.


CONCLUSIONS
Preliminary results of a prevention bonus program in the German Statutory Health Insurance suggest a decrease in mean health care spending per enrollee. These effects may increase with time as long term effects of prevention become effective. However, further research is needed to understand how much of these short-term cost reductions can be attributed to the program itself rather than to possible confounders or volunteer bias and how the short-term savings may be accrued.
Stock
Stephanie
S
Institute of Health-Economics and Clinical Epidemiology, University of Cologne, Germany. Stephanie.Stock@uk-koeln.de
Stollenwerk
Björn
B
Klever-Deichert
Gabriele
G
Redaelli
Marcus
M
Büscher
Guido
G
Graf
Christian
C
Möhlendick
Klaus
K
Mai
Jan
J
Gerber
Andreas
A
Lüngen
Markus
M
Lauterbach
Karl W
KW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000517:prevention & control*; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D005858:Germany; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009042:Motivation; D009313:National Health Programs / Q000191:economics*; D011247:Pregnancy; D011446:Prospective Studies; D012054:Reinforcement, Psychology; D014040:Token Economy