Rationale for incentive systems

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.

Maximise efficiency of services—Individual behaviour also has implications for the efficient operation of a healthcare system. Many incentive schemes seek to encourage responsible use of resources—for example, by rewarding compliance with treatment or minimising use.

Enhance competition between sickness funds—Germany’s social health insurance system has around 200 sickness funds, and citizens have free choice of fund.5 Incentive programmes serve as tools for attracting and retaining clients, in much the same way airlines or supermarkets use loyalty schemes.6

Some incentive schemes seek to satisfy all three of these goals, whereas others may focus on one or two of them.

Incentive systems in practice

Sickness funds offering incentive programmes are bound by the provisions set out in …