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[Opportunities and risks of managed care]
1Bereich Gesundheitsmanagement und Medizin, Allianz Private Krankenversicherungs-AG, Munich. michael.wiechmann@allianz.de
Aim:
The present paper aims at analysing and discussing managed care with its opportunities and risks. This analysis should be a further basis for a reasonable discussion concerning the implementation of managed care elements in the German Health Care system.
Method:
On the basis of an update literature research the relevant international experiences with managed care in several health care systems--especially in the United States and Switzerland--are analysed and described. Most relevant opportunities and risks of managed care are deduced from this analysis.
Results:
The most important opportunities of managed care are the stabilisation of health care costs, an improvement of health care processes and quality and a stronger consideration of preventive measures. The possibility of choosing between several health care models and more convenient health insurance fees are opportunities for the patients. Relevant risks of managed care involve the potential withholding of medical care with the necessity of a comprehensive quality assurance and negative influences on the physicians' autonomy. Furthermore, managed care may have negative effects on the relationship between patients and physicians or between general practitioners and medical specialists.
Conclusions:
Managed care has proven advantages in respect of cost stabilisation and quality improvement compared with traditional health care systems. If the risks and known problems of managed care are realised and avoided, the available opportunities could be an important option to reform the German Health Care system in respect of costs and quality.