[Strengthening the patients' position--a new challenge to public health]

Prevention and health promotion are well-established strategies to reduce the demand for health care. Nevertheless efforts to encourage the empowerment of consumers vis-à-vis the providers of health-care are relatively new in Germany. Programmes intended to improve a person's level of confidence in dealing with chronic illness have been shown to lower costs. The potential for reducing demand for unnecessary interventions may save money and increase the quality of provided health care. The views of consumers and their personal experiences are crucial in establishing a more effective quality management in the German health care system in Germany. At present patients are not always sufficiently involved in the process of clinical decision-making and often their knowledge does not enable them to assess the quality of services rendered. In comparison with other European countries the position of German patients is rather weak. The backing of patients' interests by insurance companies is more developed in Belgium, self-organisation of patients is established in Switzerland and, with strong government support, in the Netherlands (Kranich, 1997). However in Germany there is now growing interest in providing support for patients' participation in the choice of treatment, quality of health care and decision-making strategies for health problem management. The German Ministry of Health is currently working on a Patients' Charter to guarantee patients' rights. The Public Health Service could play its role in representing patients' interests more intensively. Health-insurance companies could concentrate more on educating the consumer in order to encourage better informed decisions and to reduce the frequency of unnecessary health care procedures. The benefits yielded by self-management of health problems (not to be confused with self-treatment), of chronic disease or disability are well-documented and may ultimately even lower medical costs. In this article, various approaches to stimulate patients' empowerment are suggested with the context of the German Health Care System.