Financial incentives for disease management programmes and integrated care in German social health insurance

• Published in: Health policy (Amsterdam) 2006-10, Vol.78 (2), p.295-305
• Main Authors: Greß, Stefan, Focke, Axel, Hessel, Franz, Wasem, Jürgen
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Delivery of Health Care, Integrated - utilization; Disease Management; Female; Germany; Health administration; Health care reform; Humans; Infant; Male; Managed care; Middle Aged; Motivation; National Health Programs; Risk Adjustment
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2005.11.011

As a result of recent health care reforms sickness funds and health care providers in German social health insurance face increased financial incentives for implementing disease management and integrated care. Sickness funds receive higher payments form the risk adjustment system if they set up certified disease management programmes and induce patients to enrol. If health care providers establish integrated care projects they are able to receive extra-budgetary funding. As a consequence, the number of certified disease management programmes and the number of integrated care contracts is increasing rapidly. However, contracts about disease management programmes between sickness funds and health care providers are highly standardized. The overall share of health care expenses spent on integrated care still is very low. Existing integrated care is mostly initiated by hospitals, is based on only one indication and is not fully integrated. However, opportunity to invest in integrated care may open up innovative processes, which generate considerable productivity gains. What is more, integrated care may serve as gateway for the introduction of more widespread selective contracting.