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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

Author

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

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.

Suggested Citation

  • Henke, Klaus-Dirk & Rich, Robert F. & Steinbach, Axel & Borchardt, Katja, 2004. "Auf dem Wege zu einer integrierten Versorgung: Neue sozialrechtliche Rahmenbedingungen unter Berücksichtigung der Erfahrungen aus den USA und am Beispiel Berlins," Discussion Papers 2004/12, Technische Universität Berlin, School of Economics and Management.
  • Handle: RePEc:zbw:tubsem:200412
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    1. Wholey, Douglas & Feldman, Roger & Christianson, Jon B., 1995. "The effect of market structure on HMO premiums," Journal of Health Economics, Elsevier, vol. 14(1), pages 81-105, May.
    2. Altman, Daniel & Cutler, David & Zeckhauser, Richard, 2003. "Enrollee mix, treatment intensity, and cost in competing indemnity and HMO plans," Journal of Health Economics, Elsevier, vol. 22(1), pages 23-45, January.
    3. David M. Cutler & Louise Sheiner, 1998. "Managed Care and the Growth of Medical Expenditures," NBER Chapters, in: Frontiers in Health Policy Research, Volume 1, pages 77-116, National Bureau of Economic Research, Inc.
    4. 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.
    5. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    6. 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.
    7. 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, vol. 14(4), pages 401-418, October.
    8. Schulman, E.D. & Sheriff, D.J. & Momany, E.T., 1997. "Primary care case management and birth outcomes in the Iowa Medicaid program," American Journal of Public Health, American Public Health Association, vol. 87(1), pages 80-84.
    9. 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.
    10. Laurence C. Baker & Martin L. Brown, 1999. "Managed Care, Consolidation Among Health Care Providers, and Health Care: Evidence from Mammography," RAND Journal of Economics, The RAND Corporation, vol. 30(2), pages 351-374, Summer.
    11. 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.
    12. David M. Cutler & Mark McClellan & Joseph P. Newhouse, 2000. "How Does Managed Care Do It?," RAND Journal of Economics, The RAND Corporation, vol. 31(3), pages 526-548, Autumn.
    13. 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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    1. Kurt Hornschild & Stephan Raab & Jörg-Peter Weiß, 2005. "Die Medizintechnik am Standort Deutschland: Chancen und Risiken durch technologische Innovationen, Auswirkungen auf und durch das nationale Gesundheitssystem sowie potentielle Wachstumsmärkte im Ausla," DIW Berlin: Politikberatung kompakt, DIW Berlin, German Institute for Economic Research, edition 2, volume 10, number pbk10.

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