With reforms in the years 2000 and 2004, respectively, the German government created a new playground for actors in Germany’s health sector. In previous years, a cumulative number of events were said to seriously impair the efficiency of the health system as it was established. The recent policy can be characterized by a shift towards rationing and standardization, in short, a trend towards Managed Care (MC). This paper is supposed to take up the part of the reforms which are aimed at introducing MC practices in the German health sector. This comes mainly in the form of Integrated Service Delivery Systems (ISDS), which overcome the burden of the traditional sectoral splitting of prevailing institutions in the health economy. The state’s priorities have been cost containment and quality enhancement. Yet these goals were perceived to be unattainable at the same time due to their state of being. The primary focus of this work is to show how government outlines the compatibility of these measures and which legal context has been established to put them into practice. The first section deals with the evolution of Managed Care, outlines its instruments, and tries to figure out why this structure seems to be particularly useful in reacting to market failures in the health sector. Information asymmetries, moral hazard and public good character are problems that need to be overcome. Policy means of information, communication, technology, and networking are suitable approaches to address the above disturbances. An attempt to examine the transferability of Managed Care from the Anglo Saxon to the German system is to be undertaken. The main part of this work attempts to outline the development of ISDSs in Germany, of which the predominant version is the ‘Integrierte Versorgung’ (IV). The legal framework, contractual means, payment schemes, and possible partners in the IV system are to be analyzed just as well as factors for success of this rather new model of care provision. It follows an introduction to the concept of network organizations which will lead directly to management areas that are particularly important when setting up networks. Eventually, advantages and disadvantages for the main actors in the system of IV are listed. The last part of the paper analyzes whether ISDS are able to smooth out imponderabilities resulting from the traditional system of provision. [...]
Contents
1. Introduction
2. Managed Care
2.1. What is Managed Care?
2.2. Instruments of Managed Care
2.2.1. Gatekeeping and Specialists
2.2.2. Case and Disease Management
2.2.3. Compensation Schemes and Incentives
2.2.4. Quality Control
2.3. Evolution of Managed Care
2.4. The Three Pillars of Managed Care
2.5. Applicability of Managed Care from the US to the German System
3. Integrated Service Delivery Systems
3.1.1. Current Deficiencies and Goals to be achieved
3.2. Development and Concept
3.2.1. Legal Aspects
3.2.2. Contracting Partners
3.2.3. Compensation
3.2.4. Financing IV Structures
3.3. Factors for Success
3.4. Organization and Management
4. Quality Management in the System of IV
4.1. Results of Empirical Research
4.2. Is the IV Approach suitable for Quality Enhancements?
4.3. Quality of Provision – Contractual Means
4.4. Outlook
5. Conclusion
Objectives & Core Topics
This thesis examines the implementation of Managed Care practices within the German healthcare sector, specifically through Integrated Service Delivery Systems (ISDS/IV), to address the dual challenges of cost containment and quality enhancement. The primary research focus is to analyze how the German government establishes the legal and economic compatibility of these integrated structures to overcome traditional sectoral inefficiencies.
- Evolution and instruments of Managed Care in the US and its applicability to the German health system.
- Development, legal framework, and contractual aspects of 'Integrierte Versorgung' (IV) in Germany.
- Strategies and factors for success in building integrated network organizations.
- Methods for quality management and empirical evaluation within the system of integrated care.
Excerpt from the Book
2.1. What is Managed Care?
“There is no single valid definition of Managed Care up to this point”. The term encompasses a diverse array of institutional arrangements [and resembles] more complete contingent claim contracts. “Generally, Managed Care is understood to be a market oriented system of provision of services and insurances in the health sector, the goal of which is the efficient allocation of scarce resources”. The development of the concept was driven by the desire to reconstruct the US health system in order to contain costs and ensure high quality standards of care provision.
The main feature of this theory is the guided or ‘managed’ provision of care through the insurer, which breaks up the traditional boundaries between units of medical care, administration and finances. The underlying incentive system works in two ways: Consumers sacrifice some of the freedom to choose care providers. This might be achieved through financial stimuli. Alternatively, a predefined range of providers might be offered and patients can select any of them from the given network. Co-payments to outsiders will be considerably higher. The suppliers of medical services are directly controlled in terms of quantity regulations or guidelines determining the methodological standards.
Chapter Summary
1. Introduction: Outlines the shift in German healthcare policy towards Managed Care practices and defines the paper's focus on Integrated Service Delivery Systems as a means to improve system efficiency.
2. Managed Care: Analyzes the theoretical instruments, evolution, and incentive structures of Managed Care, and evaluates the constraints for transferring these models from the Anglo-Saxon to the German system.
3. Integrated Service Delivery Systems: Describes the legal development, contracting partners, financing, and strategic success factors for the German implementation of Integrated Service Delivery Systems (IV).
4. Quality Management in the System of IV: Discusses the requirements for quality measurement, examines current empirical results, and provides a framework for integrating quality standards into IV contracts.
5. Conclusion: Summarizes how IV structures successfully address market failures like asymmetric information and concludes that these networks, supported by legal pressure for transparency, are viable for the German market.
Keywords
Managed Care, Integrated Service Delivery Systems, IV, Health Economics, Cost Containment, Quality Enhancement, Gatekeeping, Disease Management, Network Organizations, Healthcare Reform, Incentive Schemes, Quality Management, Efficiency, Patient-Centered Care, Contracting.
Frequently Asked Questions
What is the fundamental purpose of this thesis?
The thesis aims to analyze the introduction of Managed Care practices, specifically Integrated Service Delivery Systems (ISDS), into the German healthcare sector to balance cost containment and quality enhancement.
What are the central thematic fields covered in the study?
The core fields include the economic foundations of Managed Care, the evolution of network structures, the legal framework of 'Integrierte Versorgung' (IV), and the implementation of quality management instruments.
What is the primary research question?
The research explores how the German government creates a compatible legal and institutional context for Managed Care, and whether these systems can effectively overcome traditional sector-specific inefficiencies.
Which scientific methodology is used?
The study uses a theoretical analysis combined with an examination of empirical research, regulatory framework analysis, and specific case studies of existing IV contracts.
What does the main body of the work address?
The main body evaluates the 'Integrierte Versorgung' model, focusing on contractual means, incentive schemes, the role of different partners, and the essential organizational management of these networks.
Which keywords best characterize this work?
The primary keywords are Managed Care, Integrated Service Delivery Systems (IV), Quality Management, Healthcare Reform, and Cost Containment.
How does the 'Gatekeeper Principle' function within these new systems?
The Gatekeeper acts as a coordinator, ensuring that patients receive care at the lowest appropriate level, thereby preventing unnecessary costs and streamlining medical processes.
How do IV contracts impact the relationship between physicians and insurers?
IV contracts shift the power dynamics by allowing insurance companies to directly negotiate with defined sets of providers, while physicians must navigate new incentive schemes and potential limitations on their clinical autonomy.
- Quote paper
- B.Sc. Economics and Management David Wagner (Author), 2006, The Reform of the German Health Sector: Integrated Service Delivery Systems - Cost Containment and Quality Enhancement - Attaining Diverging Ends by Similar Means, Munich, GRIN Verlag, https://www.grin.com/document/61282
