Stock Stephanie Anja Katharina, Redaelli Marcus, Lauterbach Karl Wilhelm
Institute of Health Economic and Clinical Epidemiology, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne, Germany.
Health Policy. 2007 Jan;80(1):86-96. doi: 10.1016/j.healthpol.2006.02.005. Epub 2006 Apr 4.
Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment). To balance competition and solidarity, a risk compensation scheme (RCS) was implemented two years prior to open enrollment. Since then, balancing competition and solidarity has been a key feature of all consecutive health care reforms. The implementation of disease management programs in the statutory health insurance (SHI) served the dual purpose to promote quality of care and to foster competition. Preliminary experiences suggest, that the aligning of disease management programs with a RCS can greatly aid its implementation and benefit solidarity and competition.
直到20世纪90年代，德国医疗保健立法主要由规范供应方的措施主导。诸如预算等措施旨在控制规模，并试图将医疗保健支出的增长限制在国民收入的增长范围内。为了更有效地控制成本，20世纪90年代引入了竞争元素，允许自由选择疾病基金（开放参保）。为了平衡竞争与团结，在开放参保的两年前实施了风险补偿计划（RCS）。从那时起，平衡竞争与团结一直是所有后续医疗保健改革的关键特征。法定医疗保险（SHI）中疾病管理项目的实施具有促进医疗质量和促进竞争的双重目的。初步经验表明，将疾病管理项目与风险补偿计划相结合可以极大地促进其实施，并有利于团结和竞争。
