title: Financial incentives in the German Statutory Health Insurance: new findings, new questions.
abstract: OBJECTIVE
  This paper presents findings of a mandatory three-year evaluation of a prevention bonus scheme offered in the German Statutory Health Insurance (SHI). Its objective is to describe the rationale behind the programs, analyze their financial impact and discuss their implications on potentially conflicting goals on solidarity and competition.
  
  
  METHODS
  The analysis included 70,429 insured enrolled in a prevention bonus program in a cohort study. The intervention group and their matched controls were followed for a three-year period. Matching was performed as nearest neighbor matching. The economic analysis comprised all costs relevant for Sickness Funds (SF) in the SHI and was carried out from a SHI perspective. Differences in cost trends between the intervention and the control group were examined applying the paired t-test.
  
  
  RESULTS
  Regarding mean costs there was a significant difference between the two groups of euro177.48 (90% CI [euro149.73; euro205.24]) in favor of the intervention group. If program costs were considered cost reductions of euro100.88 (90% CI [euro73.12; euro128.63]) were obtained.
  
  
  CONCLUSIONS
  The uptake of a prevention bonus program led to cost reductions in the intervention group compared to the control group even when program costs were considered. However, the results must be interpreted with caution as in addition to financial aspects, socio-economic and health-status, selection bias and the function and use of bonus programs as marketing tools, as well as their long-term sustainability should be considered in future assessments.
authors.affiliation: Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Strasse 176-178, Köln, Germany. Stephanie.Stock@uk-koeln.de
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Guido
authors.initials: G
authors.lastname: Büscher
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber
authors.forename: Anna
authors.initials: A
authors.lastname: Drabik
authors.forename: Christian
authors.initials: C
authors.lastname: Graf
authors.forename: Markus
authors.initials: M
authors.lastname: Lüngen
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000517:prevention & control*; D017046:Cost Savings; D005260:Female; D005858:Germany; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D011322:Primary Prevention / Q000191:economics*; D012054:Reinforcement, Psychology; D014040:Token Economy