Synopses & Reviews
While Germany has achieved much over the course of the last decades in providing health care to all citizens, it is undergoing an endless series of reforms. Central to almost all reforms are measures to control cost. With it comes a focus on health insurance and premium rates, by now the central benchmark for the performance of the health care system. While focusing on cost and financing, the most pressing issue has been missed: outcomes. It is becoming evident that quality between providers is significantly different, not for rare diseases but for common problems. It is becoming clear that high cost does not equal high quality, high volume of care does not equal better outcomes, nor does newer medicine necessarily imply better outcomes.
Germany is not alone in this. Many countries are on a on a collision course with patient needs and economic reality. In Redefining Health Care, Michael E. Porter and Elizabeth Olmsted Teisberg set forth a new vision of the health care system in which every actor is focused on improving value, defined as the health outcomes achieved for patients relative to the cost incurred.
In this book, Redefining German Health Care, we apply the principles of value-based health care delivery to evaluate the German system and propose a comprehensive strategy for reform. What is needed is realignment of organizational structures, measurement and reimbursement around patient value. Health care delivery needs to be restructured around interdisciplinary practice units dedicated to specific medical conditions, provider service lines be narrowed and care be organized regionally not locally. Most importantly outcomes have to be universally measured and reported. Health insurers need to adopt a more value-adding role through supporting the development of outcome measures, actively support provider and treatment choices and engage in disease management programs.
This book prescribes a powerful and actionable agenda for change. Innovative organizations in Germany have already begun to take steps in this direction. There is no need to wait for another reform. Substantial improvements can already be implemented for the benefit of the patients. It is up to us to seize this opportunity.
Review
We must thank the authors of Redefining German Health Care for changing the language of the current health care debate. Their book makes a passionate argument for moving the health care discussion beyond cost control, health insurance premiums and risk pooling. It is health outcomes that matter to patients, not insurance premiums per se.
Synopsis
Health care in Germany and in other nations is on a collision course with patient needs and economic reality. Rising costs, mounting quality problems and a diverging statutory and private insurance system, threatening the longstanding principal of solidarity, are unacceptable – and unsustainable. A new vision of the health care system is needed in which every actor is focused on improving value, defined as the health outcomes achieved for patients relative to the cost incurred.
This book applies the principles of value-based health care delivery to evaluate the German system and propose a comprehensive strategy for reform. If the German health care system is to meet the needs of German citizens, it needs to be drastically restructured. By integrating the process of care, reducing the fragmenting of services, measuring results, and helping patients get to excellent providers, Germany can achieve dramatic improvements in value. The only real solution for health care is to maximize value, not keep attempting to minimize cost.
The purpose of this book is to evaluate the structure, organization, and roles in the German system from an overall strategic perspective, based on value principals. The authors explain the degree to which the current system delivers the maximum value to patients versus serving the interests of incumbent stakeholders. Chapter 1 and 2 begin by scoping the problem, and summarizing the essential principles of a value-based health care system. Chapter 3 provides an overview of the historical development of the German system, and shows the roots of its current problems. The authors then summarize and evaluate each component of the German system in light of value-based principles in chapters 4 to 7. Chapter 8 is dedicated to results measurement, the single most important step in system transformation. Chapter 9 then provides an overall assessment of the German healthcare system and outlines a comprehensive set of recommendations for reform, including the steps needed for providers, health plans and policy makers to lead a transition to a value-based system.
Synopsis
The German health care system is on an unsustainable path with a toxic combination of rising costs and unsustainable financing. The most pressing issue has been missed though: outcomes. It is becoming evident that quality between providers is significantly different. It is becoming clear that high cost does not equal high quality, high volume of care does not equal better outcomes, nor does newer medicine necessarily imply better outcomes.
What is needed is realignment of organizational structures, measurement and reimbursement around patient value, defined as health outcomes achieved for patients relative to the costs incurred. To maximize patient value, health care delivery needs to be restructured around dedicated interdisciplinary practice units, provider service lines be narrowed, and most importantly outcomes have to be universally measured. Health insurers need to adopt a more active role in health care delivery and move beyond their myopic focus on cost.
Synopsis
At first glance, the German health care system is a model for other nations. Germany's citizens have universal access to care with free choice of providers, and pay premiums based on their income rather than their health or employment status.
However, just like other nations Germany suffers from rising costs and inconsistent quality, and reform efforts to date have failed to solve these problems. Future reform efforts must make value improvement, defined as patient health outcomes achieved per euro spent, the central goal.
This book lays out an action agenda to move Germany to a high-value
Synopsis
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.
Synopsis
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.
About the Author
Michael E. Porter is a leading authority on competitive strategy and the competitiveness of countries, regions, and cities, and the application of strategic principles to societal problems.
Table of Contents
Introduction.- Defining the Problem.- Guiding Principles of a Value-Based Health Care System.- The German Health Care System: Overview and Historical Development.- Health Insurance in Germany.- Health Care Providers.- Overall Assessment of German Health Care Providers.- The Role of Health Plans, Employers and Patients in Health Care Delivery.- Measuring the Results of Care.- Creating a High-Value German Health Care System: Overall Assessment and Recommendations.- Taxonomy of BQS Quality Indicators.