Hertie School, Berlin, Germany.
Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, The Netherlands.
Health Econ Policy Law. 2024 Apr;19(2):269-288. doi: 10.1017/S1744133123000142. Epub 2023 Sep 11.
Fragmentation in health systems leads to discontinuities in the provision of health services, reduces the effectiveness of interventions, and increases costs. In international comparisons, Germany is notably lagging in the context of healthcare (data) integration. Despite various political efforts spanning decades, intersectoral care and integrated health data remain controversial and are still in an embryonic phase in the country. Even more than 2 years after its launch, electronic health record (; ePA) users in Germany constitute only 1 per cent of the statutorily insured population, and ongoing political debates suggest that the path to broader coverage is fraught with complexities. By exploring the main stakeholders in the existing (fragmented) health system governance in Germany and their sectoral interests, this paper examines the implementation of ePA through the lens of corporatism, offering insights based on an institutional decision theory. The central point is that endeavours to better integrate health data for clinical care, scientific research and evidence-informed policymaking in Germany will need to address the roles of corporatism and self-governance.
卫生系统碎片化导致卫生服务提供不连续，降低干预措施的效果，并增加成本。在国际比较中，德国在医疗保健（数据）整合方面明显滞后。尽管数十年来进行了各种政治努力，但跨部门护理和综合健康数据仍然存在争议，在该国仍处于萌芽阶段。即使在推出电子健康记录（ePA）两年多之后，德国的 ePA 用户仅占法定参保人口的 1%，而且持续的政治辩论表明，实现更广泛覆盖的道路充满了复杂性。本文通过探讨德国现有（碎片化）卫生系统治理中的主要利益相关者及其部门利益，从社团主义的角度审视了 ePA 的实施，基于制度决策理论提供了一些见解。核心观点是，德国为改善临床护理、科学研究和循证决策的数据整合所做的努力，需要解决社团主义和自我治理的作用。
