RESUMO
The healthcare system in Germany is characterised by fragmentation and a lack of communication between the various sectors of care. Since the late 1990s, intensive efforts have been made to enhance integration. Disease Management Programs (DMPs) represent an attempt to improve the care for the chronically ill which is known to be deficient, in particular for diabetics. As quality assurance studies do not yet provide a comprehensive picture and, in the absence of convincing evaluations, surveys of health insurance customers are particularly interesting and can provide information about preferences, motivation and evaluation of the participants in the DMPs. Thus, one year into a program started in July 2004, a representative survey was carried out of participants in the DMP for diabetics (customers of BARMER Health Insurance, Neubrandenburg). (Random sample net=124). The participants were generally age 61 years or older (77.4%), and two-thirds of them had suffered from diabetes or received treatment for more than 5 years. During the program, the proportion consulting a diabetes specialist had doubled to 31%. The assessment of the quality of care had improved markedly; 19% of the participants reported an improvement in their health status. The main reasons given for participating in the program were an anticipated improvement in the quality of care and an activation of the patient's role. Analyses indicate that those who reported the most benefit from the program are the core group of the elderly chronically ill. But as this group was particularly well informed about their own disease, attention should always be paid to the possibility of social selection processes in such health programs. In future, quality assurance studies should be carried out in order to validate surveys addressing participants in DMPs and, conversely, surveys of DMP participants should be conducted to validate quality assurance findings.
