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Auf dem Wege zu einer integrierten Versorgung: Neue sozialrechtliche Rahmenbedingungen unter Berücksichtigung der Erfahrungen aus den USA und am Beispiel Berlins

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  • Henke, Klaus-Dirk
  • Rich, Robert F.
  • Steinbach, Axel
  • Borchardt, Katja
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    Abstract

    Die vollzogene Gesundheitsreform eröffnet im Rahmen des Sozialgesetzbuches neue Möglichkeiten für Managed Care Lösungen. Bislang basierte das System auf Kollektivverträgen während Managed Care selektives Kontrahieren von Versicherungen mit Leistungsanbietern vorsieht. Im Ergebnis soll der Wettbewerb zwischen den Krankenversicherungen verstärkt werden. Die Einführung von zusätzlichen Wettbewerbselementen soll eine kostengünstigere und dennoch qualitativ hochwertige Versorgung sicherstellen. In den USA ist ein Grossteil der Bevölkerung in unterschiedlichen Formen von Managed Care Organisationen versichert, deshalb soll eine kritische Analyse der amerikanischen Erfahrungen beispielhaft in die Arbeit einfließen. Kosteneinsparungen konnten dort nur mit Hilfe eines durchgängigen Managed Care Systems erreicht werden. Im Rahmen der Arbeit soll untersucht werden, inwiefern eine Managed Care Organisation in Berlin implementiert werden könnte. Als Region soll dabei der innere S-Bahnring der Stadt Berlin dienen. Dort gibt es genügend Leistungserbringer, die zu einem Netzwerk verbunden werden könnten. Als Rechtsrahmen wird eine GmbH-Lösung empfohlen. -- The latest health care reform in German provides a new codification of the social law and framework that creates the base for a managed care. Up to now social security was characterised by collective agreements whereas managed care consists of a number of selective agreements between insurance companies and providers of medical services. As a result competition between the providers should be increased. The introduction of additional market elements should improve the co-ordination of the single providers. This is for the purpose to offer a high-grade health service at lower costs. In the United States a greater part of the population is enrolled in a Managed Care Organisation (MCO) and that is why it served as an example to be critically reviewed. A reduction of costs can only be realised when the Managed Care idea dominates all sectors of public health service and a consistent system can be founded. The present work examines the possibilities to implement a MCO in Berlin. The inner circle of the Berlin urban railway (S-Bahn) is an ideal location for the MCO. Favourable are a relatively low age of local population and a high level of education. Both criteria are correlated with a low demand of health services. Moreover in the mentioned area already exists a certain number of hospitals and medical service points that could be united to a network. The legal form of a „GmbH“ (Ltd.) fits best for this purpose.

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    Paper provided by Technische Universität Berlin, School of Economics and Management in its series Discussion Papers with number 2004/12.

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    Date of creation: 2004
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    Handle: RePEc:zbw:tubsem:200412

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    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    1. Henke, Klaus-Dirk & Berhanu, Samuel & Mackenthun, Birgit, 2003. "Die Zukunft der Gemeinnützigkeit von Krankenhäusern," Discussion Papers 2003/14, Technische Universität Berlin, School of Economics and Management.
    2. Henke, Klaus-Dirk & Borchardt, Katja & Schreyögg, Jonas & Farhauer, Oliver, 2003. "Eine ökonomische Analyse unterschiedlicher Finanzierungsmodelle der Krankenversorgung in Deutschland," Discussion Papers 2003/4, Technische Universität Berlin, School of Economics and Management.
    3. Henke, Klaus-Dirk, 2004. "Was ist uns die Gesundheit wert? Probleme der nächsten Gesundheitsreformen und ihre Lösungsansätze," Discussion Papers 2004/2, Technische Universität Berlin, School of Economics and Management.
    4. David M. Cutler & Louise Sheiner, 1997. "Managed Care and the Growth of Medical Expenditures," NBER Working Papers 6140, National Bureau of Economic Research, Inc.
    5. Daniel Altman & David M. Cutler & Richard Zeckhauser, 2000. "Enrollee Mix, Treatment Intensity, and Cost in Competing Indemnity and HMO Plans," NBER Working Papers 7832, National Bureau of Economic Research, Inc.
    6. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    7. Henke, Klaus-Dirk, 2003. "Wie lassen sich Gemeinwohl und Wettbewerb in der Krankenversicherung miteinander verbinden? Eine nationale und europaweite Herausforderung," Discussion Papers 2003/2, Technische Universität Berlin, School of Economics and Management.
    8. Goldman, Dana P. & Hosek, Susan D. & Dixon, Lloyd S. & Sloss, Elizabeth M., 1995. "The effects of benefit design and managed care on health care costs," Journal of Health Economics, Elsevier, Elsevier, vol. 14(4), pages 401-418, October.
    9. Wholey, Douglas & Feldman, Roger & Christianson, Jon B., 1995. "The effect of market structure on HMO premiums," Journal of Health Economics, Elsevier, Elsevier, vol. 14(1), pages 81-105, May.
    10. Johannes Schwarze & Hanfried H. Andersen, 1999. "Hausarztmodell und Praxisnetze: Zustimmung der Versicherten zu integrierten Versorgungsformen erkennbar," DIW Wochenbericht, DIW Berlin, German Institute for Economic Research, vol. 66(9), pages 187-191.
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