The Role of Evidence-Based Guidelines in Managed Care Pilot Projects in Germany

Abstract

Purpose: This paper outlines recent fundamental changes in the framework of the German health care system and presents diverse managed care projects and initiatives to standarize patient management using guidelines as a response to these changes.

Main findings: Increasing health care costs and a decline in budget to the statutory health insurances have urged fundamental structural changes in the long-existing German health care system. New legislation introduced competition between health insurers and pushed for pilot projects in managed care. The concepts of some of the new initiatives are presented. All initiatives recognized the need for standardization and disease management, supported by guidelines. The consensus-based guidelines produced by different stakeholders, however, did not prove helpful in patient management. The foundation for an evidence-based, scientifically sound guideline development process has been laid by physicians’ organizations.

Conclusions: The most recent changes to the health care system are promising. Their impact on urgently needed changes in the health care system remains to be seen.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    U.S. Congress, Office of Technology Assessment, Health Care Technology and its Assessment in Eight Countries. OTA-BP-H-140. Washington, DC: U.S. Government Printing Office; February 1995.

    Google Scholar 

  2. 2.

    Schwartz FW, Busse R. Germany. In: Chris Ham (ed.). Health Care Reform. Learning from International Experience. Buckingham, UK, Philadelphia, USA: Open University Press; 1997:105–118.

    Google Scholar 

  3. 3.

    Beske F, Brecht JG, Reinkemeier A-M. The Health Care System in Germany. 2nd ed. Cologne; 1995.

    Google Scholar 

  4. 4.

    Busse R, Howorth C, Schwartz FW. The future development of the rights based approach to health care in Germany: more rights or fewer? In: Hard Choices in Health Care: Rights and Rationing in Europe. Lenaghan J, ed. London: Br Med J.; 1997: 21–47.

    Google Scholar 

  5. 5.

    Advisory Council for the Concerted Action in Health Care. Health Care and Health Care Insurance. Baden-Baden: Nomos-Verlag; 1994.

    Google Scholar 

  6. 6.

    Wahner-Roedler DL, Knuth P, Juchems RH. The German Health Care System. Mayo Clinic Proceedings. 1997;72:1061–1068.

    CAS  Article  Google Scholar 

  7. 7.

    Buschmann P. Managed care models in Germany: Regional Office Network Kiel (RPK). Presented at the 47 German Physicians Congress, Berlin, May 27–29, 1998.

    Google Scholar 

  8. 8.

    Wald A. Managed care from the perspective of the company sickness funds (BKK), and Dreykluft H.-R. Managed care from the perspective of a net-work physician. Presented at the 47th German Physicians Congress, Berlin, May 27–29, 1998.

    Google Scholar 

  9. 9.

    Mehl E, Becker-Behles S. The General Sickness Funds (AOK)—Project on Diabetes in Thuringia. Berliner Änte. 1998;7:16–17.

    Google Scholar 

  10. 10.

    Gerlach FM, Beyer M, Szecsenyi J. Guidelines in Hospital and Ambulatory Settings. Dt. Ärzteblatt. 1998;95(17):A-1014–1021.

    Google Scholar 

  11. 11.

    Expert Advisory Panel of the National Council for the Concerted Action. Health Care and Health Care Insurance. Health Care and Health Insurance 2000. Individual Responsibility, Subsidiarity, Solidarity in a Changing Environment. Experts Report 1994. Eigenverlag o.O. 1994.

    Google Scholar 

  12. 12.

    Expert Advisory Panel of the National Council for the Concerted Action. Health Care and Health Care Insurance. Health Care and Health Insurance 2000. More Outcome Orientation, Higher Quality, Higher Efficiency. Special report. Baden-Baden: Nomos-Verlagsgesellschaft; 1995.

    Google Scholar 

  13. 13.

    http://www.uni-duesseldorf.de/WWW/AWMF/awmfleit.htm. Scientific Medical Societies. Home-page of Guidelines. Most Recent Update 1/12/1998. Accessed 8/4/1999.

  14. 14.

    Grol R, Lawrence M. Quality Improvement by Peer Review. Oxford: Oxford University Press; 1995.

    Google Scholar 

  15. 15.

    Agency of Quality in Medicine, https://www.dgn.de/kammern_kven/AEZQ/. Accessed: 8/4/1999.

  16. 16.

    Field MJ, Lohr KN (eds). Guidelines for clinical practice. From development to use. Washington, DC: National Academy Press; 1992.

    Google Scholar 

  17. 17.

    German Medical Association, National Association of Statutory Health Insurance Physicians. Quality Criteria for the Assessment of Guidelines in Health Care. Dt. Ärzteblatt 1997;94:A2154–2155.

    Google Scholar 

  18. 18.

    Ollenschläger G, Helou A, Kostovic-Cilic L et al. Checklist for the methodologic quality of guidelines. ZaeFQ. 1998;92:191–194.

    Google Scholar 

  19. 19.

    Luhmann D, Raspe H (1998) Establishing priorities. Influence of Evidence-based Medicine on Health Care Policy. Berliner Ärzte. 35:3/98, 19–20.

    Google Scholar 

  20. 20.

    Advisory Council for the Concerted Action in Health Care. Health Care System in Germany. Economic Burden and Industry of the Future. Volume II. Special report 1997. Eigenverlag o.O. 1997.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr. Regina Kunz MD, MSC (Epi).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kunz, R., Pientka, L. The Role of Evidence-Based Guidelines in Managed Care Pilot Projects in Germany. Ther Innov Regul Sci 33, 689–697 (1999). https://doi.org/10.1177/009286159903300305

Download citation

Key Words

  • Managed care
  • Evidence-based
  • Guidelines
  • Pilot project
  • Health care systems