Schang Laura, Thomson Sarah, Czypionka Thomas
LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England, United Kingdom; Department of Management, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England, United Kingdom; Department of Health Services Management, Ludwig-Maximilians-Universität München Schackstraße 4, 80539 Munich, Germany.
LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England, United Kingdom; Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England, United Kingdom.
Health Policy. 2016 Mar;120(3):281-92. doi: 10.1016/j.healthpol.2016.02.002. Epub 2016 Feb 8.
Understanding why policies to improve care for people with chronic conditions fail to be implemented is a pressing issue in health system reform. We explore reasons for the relatively high uptake of disease management programmes (DMPs) in Germany, in contrast to low uptake in Austria. We focus on the motivation, information and power of key stakeholder groups (payers, physician associations, individual physicians and patients).
We conducted a comparative stakeholder analysis using qualitative data from interviews (n=15 in Austria and n=26 in Germany), legal documents and media reports.
Stakeholders in Germany appeared to have systematically stronger motivation, exposure to more positive information about DMPs and better ability to implement DMPs than their counterparts in Austria. Policy in Austria focused on financial incentives to physicians only. In Germany, limited evidence about the quality improvement and cost savings potential of DMPs was mitigated by strong financial incentives to sickness funds but proved a fundamental obstacle in Austria.
Efforts to promote DMPs should seek to ensure the cooperation of payers and patients, not just physicians, using a mix of financial and non-financial instruments suited to the context. A singular focus on financially incentivising providers is unlikely to stimulate uptake of DMPs.
了解为何改善慢性病患者护理的政策未能得到实施，这是卫生系统改革中的一个紧迫问题。我们探究了德国疾病管理项目（DMPs）采用率相对较高，而奥地利采用率较低的原因。我们重点关注关键利益相关者群体（支付方、医师协会、个体医师和患者）的动机、信息获取情况及影响力。
我们利用访谈的定性数据（奥地利15例，德国26例）、法律文件和媒体报道进行了一项比较性利益相关者分析。
与奥地利的利益相关者相比，德国的利益相关者似乎在推动DMPs方面有着更强的系统性动机，接触到更多关于DMPs的正面信息，且实施DMPs的能力更强。奥地利的政策仅侧重于对医师的经济激励。在德国，尽管关于DMPs质量改善和成本节约潜力的证据有限，但对疾病基金的强劲经济激励减轻了这一影响，而在奥地利，这却成为了一个根本性障碍。
推广DMPs的努力应寻求确保支付方和患者的合作，而不仅仅是医师的合作，要运用适合具体情况的一系列财务和非财务手段。单纯注重对医疗服务提供者进行经济激励不太可能刺激DMPs的采用。
