Disease management programmes in Germany: a fundamental fault

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Germany implemented disease management programmes (DMPs) in 2001 to incentivize healthcare providers.
• These programs aimed to enhance the treatment of chronically ill patients.
• By March 2005, over 3,200 DMPs were approved, covering approximately one million patients, primarily for diabetes, breast cancer, and coronary heart disease.

Purpose of the Study:

• To evaluate the financial incentives within German disease management programmes (DMPs).
• To assess the alignment of reimbursement mechanisms with DMP objectives.
• To provide preliminary evidence on the performance of German DMPs.

Main Methods:

• Analysis of the financial incentive structures for sick funds in German DMPs.
• Examination of physician reimbursement models in relation to DMP requirements.
• Review of preliminary evidence on the effectiveness and performance of the implemented DMPs.

Main Results:

• German DMPs exhibit significant flaws in their financial incentive design.
• Sick funds receive increased risk adjustment transfers upon patient enrollment, irrespective of treatment improvement.
• Physician reimbursement is not optimally targeted to meet the specific needs of DMPs, potentially hindering effective care delivery.

Conclusions:

• The current financial incentives in German DMPs may not effectively drive improved treatment for the chronically ill.
• The lump-sum transfer system for sick funds does not guarantee enhanced patient care.
• Preliminary findings indicate a poor performance of German DMPs, suggesting a need for significant reform in incentive and reimbursement structures.