Clemens Guth

The German health care system is on a collision course with budget realities. Costs are high and rising, and quality problems are becoming ever more apparent. Decades of reforms have produced little change to these troubling trends. Why has Germany failed to solve these cost and quality problems? The reason is that Germany has not set value for patients as the overarching goal, defined as the patient health outcomes achieved per euro expended. This book lays out an action agenda to move Germany to a high value system: care must be reorganized around patients and their medical conditions, providers must compete around the outcomes they achieve, health plans must take an active role in improving subscriber health, and payment must shift to models that reward excellent providers. Also, private insurance must be integrated in the risk-pooling system. These steps are practical and achievable, as numerous examples in the book demonstrate. Moving to a value-based health care system is the only way for Germany to continue to ensure access to excellent health care for everyone.

The German health care system is on a collision course with budget realities. Costs are high and rising, and quality problems are becoming ever more apparent. Decades of reforms have produced little change to these troubling trends. Why has Germany failed to solve these cost and quality problems? The reason is that Germany has not set value for patients as the overarching goal, defined as the patient health outcomes achieved per euro expended. This book lays out an action agenda to move Germany to a high value system: care must be reorganized around patients and their medical conditions, providers must compete around the outcomes they achieve, health plans must take an active role in improving subscriber health, and payment must shift to models that reward excellent providers. Also, private insurance must be integrated in the risk-pooling system. These steps are practical and achievable, as numerous examples in the book demonstrate. Moving to a value-based health care system is the only way for Germany to continue to ensure access to excellent health care for everyone.

Das deutsche Gesundheitssystem ist auf Kollisionskurs mit der ökonomischen Realität. Die Kosten sind hoch und steigen weiter, und Qualitätsprobleme bei den Leistungserbringern werden immer offensichtlicher. Jahrzehnte von Reformen haben diesen besorgniserregenden Trend kaum geändert. Warum hat es Deutschland nicht geschafft, die Kosten- und Qualitätsprobleme zu lösen? Das heutige System ist dominiert von Partikularinteressen. Nicht Kostenkontrolle, sondern die Steigerung des Patientennutzens – definiert als Behandlungsergebnis pro ausgegebenem Euro – ist das Ziel, das alle Akteure vereinigen kann. Dazu muss man nicht auf die nächste Gesundheitsreform warten. Massive Verbesserungen lassen sich schon heute zum Vorteil aller verwirklichen. In den zwölf Empfehlungen des Buches geht es darum, wie sich Leistungserbringer um Krankheitsbilder organisieren, wie Wettbewerb um messbare Ergebnisqualität die Norm wird, wie Krankenkassen eine aktivere Rolle in der Gesundheit ihrer Versicherten einnehmen und wie das Vergütungssystem zukünftig Exzellenz in der Versorgung einzelner Krankheitsbilder belohnen sollte. Darüber hinaus zeigen die Autoren, warum die Einbindung der Privaten Krankenversicherung in den Risikostrukturausgleich der Gesetzlichen Krankenkassen unausweichlich ist. Wenn der Patientennutzen in den Mittelpunkt gestellt wird, entstehen Chancen für alle.