[Prevention and law. The legal regulation of prevention in health care].
OBJECTIVE
Law has to make order. The more complex a subject matter is, the more intensive it is usually legally regulated. As such, in Germany health care is an intensively regulated area with an own social code. For prevention, no such code exists, even though it is often praised as the fourth pillar of health care. Two attempts to enact a Prevention Act have failed. Therefore, this study analyzes how prevention is currently regulated in Germany.


METHODS
The study evaluates the existing laws that govern prevention and health promotion. For this purpose, the respective legal provisions are analyzed and, then, an overall view of the legal rules and their interplay is performed.


RESULTS
The legal regulation of prevention is based on a number of different laws. Mainly, two groups of legal provisions can be differentiated. The first group ist attributable to the field of danger defense. The second group regulates the specific prevention in heath care and health promotion and is part of social law. Most social codes encompass detailed provisions on prevention governing and regulate nearly all stages of prevention. Prominent roles are played by the health and accident insurance laws and rehabilitation laws.


CONCLUSIONS
Even in the absence of a specific Prevention Act, prevention is not practiced without a legal fundament. However, this legal regulation of prevention is structured heterogeneously and built by several laws that either stand parallel side by side or are interwoven. Further, this legal frame involves all social insurance carriers and several authorities. Prevention is a joint effort. Nevertheless, a stronger concentration of the regulation of prevention would be beneficial to strengthen prevention. This is even more so as from a health economic perspective the current coexistence and interaction of numerous laws and authorities is often inadequately expensive. Therefore, the cost-benefit ratio of the legal regulation of prevention seems improvable.
Koyuncu
Adem
A
Rechtsanwaltskanzlei MAYER BROWN LLP, Köln. akoyuncu@mayerbrown.com
Kirch
Wilhelm
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000331:legislation & jurisprudence; D005858:Germany; D006293:Health Promotion / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D011314:Preventive Health Services / Q000191:economics / Q000331:legislation & jurisprudence*; D055815:Young Adult