Szymkowiak Christof, Walkenhorst Karen, Straub Christoph
Z Arztl Fortbild Qualitatssich. 2003 Jun;97(3):201-6.
Disease Management Programmes represent a great challenge to the German statutory health insurance system. According to politicians, disease management programmes are an appropriate tool for increasing the level of care for chronically ill patients significantly, while at the same time they can slow down the cost explosion in health care. The statutory health insurers' point of view yields a more refined picture of the chances and risks involved. The chances are that a medical guideline-based, evidence-based, co-operative care of the chronically ill could be established. But also, there are the risks of misuse of disease management programmes and of misallocation of funds due to the ill-advised linkage with the so-called risk compensation scheme (RSA) balancing the sickness funds' structural deficits through redistribution. The nation-wide introduction of disease management programmes appears to be a gigantic experiment whose aim is to change the care of chronically ill patients and whose outcome is unpredictable.
疾病管理计划对德国法定医疗保险体系构成了巨大挑战。据政界人士称，疾病管理计划是大幅提高慢性病患者护理水平的合适工具，同时还能减缓医疗保健费用的激增。法定医疗保险机构的观点则更清晰地展现了其中的机遇与风险。机遇在于，有可能建立起基于医学指南、循证且合作的慢性病护理模式。但同样存在风险，即由于与所谓的风险补偿计划（RSA）不明智地挂钩，可能导致疾病管理计划被滥用以及资金分配不当，而风险补偿计划是通过重新分配来平衡疾病基金的结构性赤字。在全国范围内推行疾病管理计划似乎是一场规模巨大的试验，其目的是改变慢性病患者的护理方式，而结果难以预测。
