Overview

Reimbursement methods in competitive health insurance systems may give health plans incentives to avoid enrolling high-risk individuals. In Germany, where most people are covered through private non-profit sickness funds, required contributions are pegged to each fund's costs. People have been allowed to choose among funds since 1996, and there has been a steady migration of younger and healthier enrollees to lower-cost plans. Plans with higher numbers of chronically ill participants have been penalized. A new disease management initiative aims both to create incentives for health insurers to enroll chronically ill people and to improve quality and efficiency of care through the use of evidence-based guidelines and protocols, formularies of effective drugs, and improved coordination. A fund that chooses to establish a disease management program will receive added compensation for each person enrolled. Programs may be established for any of four conditions—diabetes, breast cancer, asthma, and coronary heart disease—and must meet national procedural and quality standards. The first initiatives, regional programs for breast cancer and diabetes, became operational in early 2003. For more information, see Disease Management Programs In Germany's Statutory Health Insurance System in the May/June 2004 issue of Health Affairs.