Utilization Dynamics of an Integrated Care System in Germany: Morbidity, Age, and Sex Distribution of Gesundes Kinzigtal Integrated Care’s Membership in 2006–2008

Abstract

‘Gesundes Kinzigtal Integrated Care’ (GKIC) is one of the few population-based integrated care systems in Germany. By coordinating health care utilization for a defined population in the Kinzigtal region in southwest Germany, GKIC strives to increase the quality of the local health care system and to curb rising health care costs in the region. GKIC explicitly refrains from preferably selecting the traditional “good risks.” Instead, GKIC has adopted an elaborate contractual framework that incentivizes GKIC providers to enroll rather high-risk and high-morbidity insurants. These incentives are designed to induce GKIC and the associated health care providers to first and foremost recruit older people and insurants with an above-average morbidity or morbidity risk into the integrated care network.

First, the authors outline the main features of GKIC, focusing on the incentives which are to lead GKIC to serve first of all the insurants with above-average morbidity. Then, they investigate to what degree GKIC has reached this latter objective: The authors analyze the sociodemographic and morbidity structure of insurants in the Kinzigtal region during the first 3 years of GKIC’s existence (2006–2008). For each of these 3 years, sociodemographic variables and morbidity figures are compared between the enrolled and the non-enrolled insurants. These analyses are based on health insurers’ claims data. The results show that GKIC has performed according to the incentives: The extended preventive and care management potential of GKIC has indeed been offered first and foremost to insurants with higher (age- and sex-adjusted) morbidity.