The German strategy for quality improvement in health care: still to improve.

One basic aim of German Health Policy is to secure a high quality of medical services financed by Statutory Health Insurance (SHI). Due to the specific relationships among patients, insurance funds and medical providers this aim is in a potential conflict with various cost-containment efforts introduced within the last 10 years. This article outlines a general theoretical framework to analyze the possible effects of these efforts on the quality of health care. It then analyzes the actual regulation approach strategy taken by German Health Policy for quality assurance in health care. Finally, it outlines a two-tier strategy based on regulation and competition as a means to ensure a high quality of care.