title: [Health insurance discount contracts: problems and risks for the general practitioner in the medical care of patients with chronic illness].
abstract: OBJECTIVE
  The German federal Health Insurance law to strengthen competition between the pharmaceutical companies commits pharmacies to hand out drugs from discount contract drug suppliers of a patient's health insurance company. Thus patients are confronted with constantly changing drug packets. This study aimed at exploring whether patients have been properly informed about the new discount contracts and if they have experienced changes and problems in their long- term medications.
  
  
  METHODS
  Between May and June 2008 male and female patients older than 50 years who had a statutory health insurance and had been diagnosed with coronary heart disease for at least one year answered a standardized questionnaire filled in by doctors' assistants or general practitioners in the doctors' network "Weschnitztal".
  
  
  RESULTS
  Of the 188 patients participated in this study 63,8% were informed about health insurance discount contracts. 31,3% of the patients reported that a positive effect due to the discount contracts was that they were discharged from paying the drug prescription fee, 22,2% mentioned that cost saving for the health insurance could also be positive. 120 patients (63,8%) knew that the names of their long-term drugs could change.101 of the questioned patients (53,7%) identified a change in their long-term drugs, 51,5% felt insecure about the permanent changes. 21,7% experienced adverse e effects due to the new drugs. 19% of the patients had serious problems regarding medication intake.
  
  
  CONCLUSIONS
  This study demonstrates that the information which patients have on the new health insurance law is not adequate enough. Many of them felt insecure because of the changes of long-term medications. One fifth of the patients reported errors in their drug intake or their confusion about their drugs. There is a high risk that these circumstances may trigger further diseases or complications. The cost savings as intended by the health insurance companies may therefore not be achieved by discount contracts.
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Fürth. rleutgeb@t-online.de
authors.forename: R
authors.initials: R
authors.lastname: Leutgeb
authors.forename: C
authors.initials: C
authors.lastname: Mahler
authors.forename: G
authors.initials: G
authors.lastname: Laux
authors.forename: Artenetz
authors.initials: A
authors.lastname: Weschnetz
authors.forename: J
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy; D032982:Contracts / Q000191:economics / Q000331:legislation & jurisprudence*; D003327:Coronary Disease / Q000188:drug therapy*; D017046:Cost Savings / Q000191:economics / Q000331:legislation & jurisprudence; D016527:Drug Costs / Q000331:legislation & jurisprudence; D004346:Drug Information Services; D004349:Drug Packaging; D016568:Drugs, Generic / Q000009:adverse effects / Q000191:economics* / Q000592:standards*; D005194:Family Practice; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D010353:Patient Education as Topic; D010821:Physicians, Family / Q000523:psychology; D055553:Prescription Drugs / Q000009:adverse effects / Q000191:economics / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013810:Therapeutic Equivalency
chemical_list: D016568:Drugs, Generic; D055553:Prescription Drugs