Managed care

Managed care is a control model in health care. The free choice of doctor and the market mechanisms are limited in favor of planned, contractually regulated processes to reduce costs and increase the quality of care. Patients can a managed care system join voluntarily, about to get reductions in contributions, or they are insured in a health maintenance organization (HMO ) ( for example, common in the U.S. ) by the employer. Providers also bind itself contractually to a management -care system. Often they get there no fee for service, but a fixed budget, and / or are involved with a share of cost and profit.

In Germany and Switzerland, the legislators wish practitioner networks with budget responsibility: in Germany since 2009 as a so-called GP-centered care ( § 73b SGB V, recast with the law to the development of organizational structures in SHI ), in Switzerland since 1996 ( Insurance Act). It includes a number of general practitioners a common selective contract (that is, outside of the budget of KV ) with one or more insurers, in which a framework for all costs included in this contract the insured is determined. At a cost underrun, the network receives a bonus for exceeding a penalty. The insured who join such a network, obtain a reduced premium.

In the Dutch health care system there is also the family doctor as so-called gatekeeper: Patients must always first go to one allocated to them based on the neighborhood family doctor. Number and places of establishment of these basic utilities are strictly regulated. The primary care physicians have little equipment or facilities - neither practice nor X-ray laboratory - and have further if required. In Germany, which is regulated only on a voluntary basis with participation in individual disease management programs so.

Solved and unsolved problems

• Less supply and less reserve capacity. Waiting lists. In economically computing managers of a managed -care system tends to the capacity to measure as close as possible to achieve a high utilization. This results in a cost savings, but also a waiver of reserve capacity, which manifests itself in often long waiting times. ( In the Netherlands, for example, for a blood one to two weeks for non-vital operations to several months. ) As the patients during these waiting times are often limited or unable to work and as long-term consequences of late treatment are not excluded, can such savings in health care to incalculable social costs lead.

• Inverted incentive system. If providers are not rewarded for the provision, but to a certain extent for the avoidance of services, there is a tendency - more or less unconsciously - actually save necessary services. This must be compensated by appropriate quality control mechanisms. Accordingly, the temptation to over-treatment, unnecessary and expensive therapies and waste must be fought in the traditional models.

Current importance in Switzerland

In Switzerland, on 1 January 2004 were just under 500,000 ( of a total of about 7 million ) insured in managed care models, 100,000 of them in HMOs, 400,000 in Private Practice. If insurers offer family doctor insurance, contact these usually 30 to 50 percent of the insured at. In the HMO, there are less since are not already known to the doctors here.

On 17 June 2012, the Swiss people had voted on a bill that would increase the proportion of insured persons in integrated care models to 60 percent. For the rejection, the SP, SVP and BDP spoke out, the other parties gave the Yes - known slogan. This template was rejected at a stake of 38.0 percent with 76 percent of votes against ( 1'480'889 466'996 No to Yes ). With over 91 percent of votes against was in the Canton of Vaud Canton of Ticino ( 87.5 percent ) and the Canton of Geneva (87 percent), the biggest rejection of the proposal. There has been a template that came out of the Parliament (National Council and Council of States), rejected rarely with so many negative votes, the result surprised.

Current importance in Germany

First approaches to the realization of managed care in the German statutory health insurance are disease management programs and integrated care. A significant expansion is discussed in connection with a change to the shopping model for inpatient and outpatient care.