[What are the economic advantages of Integrated Health Care?]. / Wo liegen die Chancen der Integrierten Versorgung aus ökonomischer Sicht?

Integrated Health Care and Managed Health Care are both tools to implement broader responsibilities of health care providers for the economic efforts of their activities. While Managed Care is quite common in the United States of America, experiences with such systems are sparse in Europe and Germany. With Integrated Health Care, new types of markets will emerge: not only a market for health care services, but also for insurance contracts, and for provision of care. The paper discusses different incentives arising from different health care systems.

[Cost of illness studies as a basis for decision making]. / Die Krankheitskostenrechnung als Entscheidungshilfe.

Definitions and methods for cost of illness studies are explained: costs, direct costs, indirect costs, intangible costs, the human capital method and the willingness to pay approach. Devaluing the long-term health benefits from prevention by constant discount rates is questioned. The development and the state of the art of cost of illness studies at a national level in Germany are discussed. As an example the newly developed cost of illness study of the Federal Statistical Office with direct and indirect costs of circulatory diseases is presented. Reasons for the benefit of cost of illness studies for decision making are given in the context of costs of illness and aging.

[Control of health care by the economist?]. / Steuerung des Gesundheitswesens durch den Okonomen?

Although the health care system has to deal with huge financial problems one cannot neglect that this labour-intensive service branch creates the most jobs with social security obligations. Corrective strategies will have to increase the orientation of health care to patients' needs which requires better information and more decision-making autonomy for the insured people as well as a maximising of efficiency. Competition needs to be strengthened in order to improve quality and reduce costs. This requires more contractual freedom for insurance funds and a dismantling of the current monopolistic structures. Finally, adequate remuneration schedules and patients' individual responsibility play a major role to meet the future challenges in the European internal market.

[Neonatal hearing screening--consequences for public health policy]. / Neonatales Hörscreening--gesundheitspolitische Konsequenzen.

In Germany 1-2 of every thousand newborns suffer from severe hearing impairment. The fatal consequences of this irreversible condition are avoidable only if therapy is started as early as possible--according to current US-American recommendations before the age of 6 months. In Germany children even with severe hearing loss are identified only when they are 21 months old (average figure). Universal hearing screening before the age of 3 months could be a useful measure to reduce the mean age of children at the time of diagnosis and so to give them a chance of an early and promising therapy. In the USA this has been recommended by the National Institute of Health since 1993.

The German health care system: structure and changes.

The German health care system has often been viewed by American policy makers as a model for a system that controls costs and provides coverage to virtually all of its citizens, while maintaining a private market for the delivery of most services. Nevertheless, German policy makers are as concerned as their American counterparts about the increasing share of national income devoted to health care. To control rising health care costs, the German government, after two decades of cost control interventions, has enacted a major health care reform aimed at reducing structural deficits of the current system and enhancing competition within the system. We review the general structure of the German health care system and analyze its specific problems. We also discuss its accomplishments and present the recently enacted health care reform.

Global budgeting in Germany: lessons for the United States.

In 1993 Germany implemented significant health reform legislation that, among other things, strengthened the global budgeting of physicians and instituted global budgeting of pharmaceutical expenditures. German physician expenditures are now capped at the growth in income of members of the sickness funds, in contrast to prior years, in which some growth above a targeted level was allowed. For the first time, dental services also are subject to the budget cap. The new reform legislation also limits growth in pharmaceutical expenditures by increasing the level of copayments and by placing physicians as a group at financial risk for growth over the limit. This paper examines the effect of these reforms during the first year and offers lessons for reform of the U.S. system.

Financing a national health insurance.

Financing national health insurance is a topic that has been discussed for a long time in the United States. It is also of relevance for less developed countries, in particular in the Far East where some countries have just introduced or are on the brink of introducing national health insurance. Furthermore, there is an urgent need to consult those former socialist countries wishing to introduce a national health insurance system. The paper deals with basic principles of health insurance and specific elements of a (compulsory) social health insurance in detail.

The economic cost of illness in the Federal Republic of Germany in the year 1980.

This paper provides an empirical investigation of the economic cost of illness, disability and premature death in the Federal Republic of Germany in the year 1980. Direct and indirect cost of morbidity and mortality are estimated and allocated to the disease categories of the ICD-International Classification of Diseases. Against the background of increasingly scarce resources in health care, the findings of cost of illness studies obtain special significance for the setting of priorities for the allocation of these resources. In comparison to the status quo, a disease-oriented approach may provide a more differentiated and national basis for the ex-ante macro-allocation of health care resources as well as for the identification of areas for increased efforts in prevention.

A "concerted" approach to health care financing in the Federal Republic of Germany.

An overview is given on how the German health care system is financed, on the 'concerted action approach to health care' and on the long-term perspectives of the statutory sickness fund system as the very heart of the financing system. In all three parts the effects of different ways of financing on the allocation of health care resources and their distributional effects are dealt with. As the concerted action appears as a 'third way' between a pro-competition strategy and a governmental approach to health care and differs from the way other countries organize the allocation of health care resources it is given special emphasis.

[Economic aspects of health care for the elderly]. / Okonomische Aspekte der Gesundheitsversorgung der Uber-Sechzigjährigen.

Group-specific analysis of health care in the Federal Republic of Germany is in its infancy. Health care of the elderly is discussed in regard to health status, utilization, expenditures and financing. The empirical approach offers results that are of importance in a policy context, in particular if they are further developed by an interdisciplinary effort in health services research. The results, if published regularly, provide answers to the question whether supply and utilization of health services correspond with the need of the elderly.