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What Can We Learn from German Health Incentive Schemes?

The Issue

Since 1989, Germany has introduced a variety of incentive schemes into its health care system to improve population health, maximize efficiency, and enhance competition among its sickness funds (nonprofit health insurance providers).


What the Study Found

According to this Commonwealth Fund–supported study, the most popular German incentive programs are aimed at:

  • Encouraging dental check-ups. Sickness funds cover an additional 20 percent of dental care costs if adults have had annual check-ups over five years.
  • Promoting health-conscious behavior. Consumers receive cash, discounts, or merchandise for participating in a variety of health promotion, screening, and check-up programs. These bonus programs are the most popular of the incentive schemes.
  • Limiting use of health services. Individuals can have their contributions or copayments reduced for participating in disease management programs or otherwise minimizing use of medical services.
  • Promoting early detection and treatment of chronic illnesses. Copayments are reduced for individuals who get screened for cervical, bowel, and breast cancer at recommended ages.

While initial evidence suggests Germany's combination of "carrot and stick" approaches has a "clear potential for cost savings," it is unclear whether the programs benefit socioeconomic groups equally—as it is "well established that people who are better off are more likely to participate in preventive measures than poorer people."


Future evaluations will determine whether the incentive programs are financially viable in the long term, the authors say. In addition, the government will need to assess "the potential for achieving sustainable behavior change" and ensuring all social groups are able to benefit.

Publication Details



H. Schmidt, A. Gerber, and S. Stock, "What Can We Learn from German Health Incentive Schemes?" BMJ, Sept. 24, 2009 339:b3504.