[Prevention and health promotion as a responsibility of legal health insurance--exemplified by a local insurance bureau].

The German statutory health insurance bodies are legally obliged to support health promotion of the assured, as stipulated by German social legislation since 1988. An analysis was performed covering a period of 5 years (1986-1990) in respect of all health-promoting and preventive measures carried out by a local so-called "Allgemeine Ortskrankenkasse (= AOK)" looking after 170,000 insured persons, to find out the impact of the new legislation on the practice of that particular local insurance body. During the period under report no changes in activities were recorded that would be worth mentioning. Although expenditure for prevention rose by 50%, it was nevertheless impossible to administer preventive measures to all the insured persons throughout the area since the total amount reserved for this purpose was only 0.42% of the overall expenditure. A major portion of the documented measures such as consultation on foods, health-promoting sports, getting rid of the smoking habit, social counselling, anti-stress training courses and the like were not performed for primary prevention but on subjects who were already sick (diabetics, cardiovascular patients, patients suffering from diseases of the locomotor apparatus). Definite statements on the quality or success of the measures were possible in selected cases only. The results of the study prompted organisational improvements in that particular insurance body. Since their financial resources are limited, these bodies should shift the emphasis of their expert possibilities in prevention to on-target care of high-risk groups and to the training of multiplicators.