Published 24 September 2009, doi:10.1136/bmj.b3504
Cite this as: BMJ 2009;339:b3504

Analysis

What can we learn from German health incentive schemes?

Harald Schmidt, research associate1, Andreas Gerber, senior researcher2, Stephanie Stock, senior researcher2

1 LSE Health, London School of Economics and Political Science, London WC2A 2AE, 2 Institute of Health Economics and Clinical Epidemiology of the University of Cologne, 50935 Cologne, Germany

Correspondence to: Harald Schmidt h.t.schmidt@lse.ac.uk

Incentives aimed at changing individual health behaviours are well established in Germany. Harald Schmidt, Andreas Gerber, and Stephanie Stock describe how they work and discuss some of the difficulties

The first 150 words of the full text of this article appear below.

Germany first introduced incentives aimed at individuals into its statutory health insurance scheme in 1989, offering reduced copayments for dental treatment to people who attended regular check-ups. Since then, many other incentive schemes have been launched. Some welcome these, but others question their rationale and effectiveness and worry that a focus on individual behaviour detracts from taking action at the social level. Despite these concerns, other countries, including the United Kingdom, have shown interest in incentive programmes.1 2 3 We look at the lessons to be learnt from Germany’s experience.

German incentive schemes have three main goals:

Improve population health—As elsewhere, chronic diseases are on the rise in Germany. Although evidence on the role of the social determinants of health is becoming increasingly irrefutable,4 even the most health conducive environments do not, by themselves, make people healthy. Targeting individual behaviour is therefore viewed as a complementary way of improving population health.

. . . [Full text of this article]


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