[Conflicting Rules and Incentives for Health Promotion and Prevention in the German Statutory Health Insurance (GKV)]

Area of Science:

• Public Health Policy
• Health Economics
• Preventive Medicine

Background:

• The German statutory health insurance (GKV) plays a role in health promotion and prevention.
• Existing regulations and incentives within the GKV framework require examination for consistency and effectiveness.
• The study assesses whether political objectives to strengthen prevention have been realized within the GKV system.

Purpose of the Study:

• To analyze the role of the German statutory health insurance (GKV) in health promotion and prevention.
• To evaluate the consistency of regulations and incentives governing GKV's preventive services.
• To determine if the GKV has successfully strengthened prevention as intended by policy.

Main Methods:

• Compilation of regulations and incentives from Sozialgesetzbuch V, the legal basis for GKV prevention.
• Analysis of the effects and interactions of these regulations and incentives.
• Examination of annual financial reports of GKV to track spending trends in overall and specific prevention areas.

Main Results:

• GKV's responsibilities in health promotion and prevention lack a strong scientific foundation.
• Inconsistent regulations and incentives create conflicting aims within the GKV.
• Only 2% of GKV expenditures are allocated to health promotion and prevention, primarily for medical check-ups and vaccinations; spending in this area has declined since 2009.

Conclusions:

• Harmonization of GKV regulations and correction of inconsistent incentives are necessary for effective health promotion and prevention.
• Different normative constructs for health promotion and various levels of prevention (primary, secondary, tertiary) should be unified given similar evidence bases.
• Incentives should align with the distinct goals of health insurers and members, with financial incentives potentially more effective when insurers lack short-term financial interests.