The European Journal of Health Economics

, Volume 20, Issue 8, pp 1181–1193 | Cite as

Economic impact of disease prevention in a morbidity-based financing system: does prevention pay off for a statutory health insurance fund in Germany?

  • Ines Weinhold
  • Christian SchindlerEmail author
  • Nils Kossack
  • Benjamin Berndt
  • Dennis Häckl
Original Paper


Preventable chronic diseases account for the greatest burden in the German health system and statutory health insurance (SHI) funds play a crucial role in implementing and financing prevention strategies. On the contrary, the morbidity-based scheme to distribute financial resources from the Central Reallocation Pool among the different sickness funds may counteract efforts of effective prevention from an economic perspective. We assessed financial impacts of prevention from a sickness funds perspective in a retrospective controlled study. Claims data of 6,247,275 persons were analyzed and outcomes between two propensity-matched groups (n = 852,048) of prevention users and non-users were compared in a 4-year follow-up. Using a difference-in-differences approach, we analyzed healthcare expenditures, the development of morbidity, financial transfers from the Central Reallocation Pool, and contribution margins. The group of prevention users develops less morbidity (incidences and disease aggravations) compared to the control group. Healthcare expenditures increase in both groups within 4 years, whereas the increase is lower for prevention users compared to non-users (€568.04 vs. €640.60, p < 0.0001). Taking morbidity-based financial transfers into account, the decrease in contribution margins is stronger for prevention users (− €188.44 vs. − €138.73, p < 0.0001). This study demonstrates an economic disincentive from a sickness funds’ perspective. In the semi-competitive SHI market, sickness funds will be discouraged from effective prevention strategies if investments are not worth it financially. Their efforts and knowledge are, however, crucial for joint action to foster prevention over cure in the health system.


Prevention Healthcare financing Incentives Regulation Competition 

JEL Classification

I10 I13 I18 



WIG2 researchers are responsible for the development of the research idea, study design, data analysis, interpretation of the results, and publication strategy. The IKK e.V., which is the representation of craft guild sickness funds, provided the data for the research and supported in the preparation of the manuscript.


The study was supported financially by the IKK e.V..

Compliance with ethical standards

Conflict of interest

The author BB was an employee of the IKK e.V., which supported the research financially. There are no other relationships or potential conflict of interest to declare.


  1. 1.
    Bundesamt, Statistisches: Krankheitskosten 2002–2008. Fachserie 12, 36–41 (2010)Google Scholar
  2. 2.
    van der Meer, R.M., Wagena, E., Ostelo, R.W.J.G., Jacobs, A.J.E., van Schayck, O.C.P.: Smoking cessation for chronic obstructive pulmonary disease. In: van der Meer, R.M. (ed.) Cochrane Database of Systematic Reviews, p. CD002999. Wiley, Chichester (2003)Google Scholar
  3. 3.
    Wendel-Vos, G., Schuit, A.J., Feskens, E.J.M., Boshuizen, H.C., Verschuren, W.M.M., Saris, W.H.M., Kromhout, D.: Physical activity and stroke. A meta-analysis of observational data. Int. J. Epidemiol. 33, 787–798 (2004). CrossRefPubMedGoogle Scholar
  4. 4.
    Ebrahim, S., Taylor, F., Ward, K., Beswick, A., Burke, M., Davey Smith, G.: Multiple risk factor interventions for primary prevention of coronary heart disease. In: Ebrahim, S. (ed.) Cochrane Database of Systematic Reviews. Wiley, Chichester (2011)Google Scholar
  5. 5.
    Rees, K., Dyakova, M., Wilson, N., Ward, K., Thorogood, M., Brunner, E.: Dietary advice for reducing cardiovascular risk. In: Brunner, E. (ed.) Cochrane Database of Systematic Reviews, p. CD002128. Wiley, Chichester (2013)Google Scholar
  6. 6.
    Busse, R., Blümel, M.: Health System Review. Health Systems in Transition. European Observatory on Health Systems and Policies. World Health Organization, Geneva (2014)Google Scholar
  7. 7.
  8. 8.
    Göpffarth, D.: Reforming Germany’s risk structure equalization scheme-taking stock at the halfway point. J. Public Health (Bangkok) 13, 248–256 (2005). CrossRefGoogle Scholar
  9. 9.
    van de Ven, W.P.M.M., Beck, K., Buchner, F., Chernichovsky, D., Gardiol, L., Holly, A., Lamers, L.M., Schokkaert, E., Shmueli, A., Spycher, S., Van de Voorde, C., van Vliet, R.C.J.A., Wasem, J., Zmora, I.: Risk Adjustment and risk selection on the sickness fund insurance market in five European countries. Health Policy (New York). 65, 75–89 (2003). CrossRefGoogle Scholar
  10. 10.
    Buchner, F., Göpffarth, D., Wasem, J.: The new risk adjustment formula in Germany: implementation and first experiences. Health Policy (New York). 109, 253–262 (2013). CrossRefGoogle Scholar
  11. 11.
    Busse, R., Drösler, S., Glaeske, G., Greiner, W., Schäfer, T., Schrappe, M.: Wissenschaftliches Gutachten für die Auswahl von 50 bis 80 Krankheiten zur Berücksichtigung im morbiditätsorientierten Risikostrukturausgleich (2007)Google Scholar
  12. 12.
    WHO: Regional Office for the Eastern Mediterranean: Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity, Accessed 3 Aug 2016
  13. 13.
    Katz, D.L., Ali, A.: Preventive medicine, integrative medicine, and the health of the public. Invited paper at the IOM Summit on Integrative Medicine and the Health of the Public., Washington, DC (2009)Google Scholar
  14. 14.
    Deutsche Adipositas-Gesellschaft: Interdisziplinäre Leitlinien der Qualität S3 zur “Prävention und Therapie der Adipositas”. Martinsried (2014)Google Scholar
  15. 15.
    Paulweber, B., Valensi, P., Lindström, J., Lalic, N., Greaves, C., McKee, M., Kissimova-Skarbek, K., Liatis, S., Cosson, E., Szendroedi, J., Sheppard, K., Charlesworth, K., Felton, A.-M., Hall, M., Rissanen, A., Tuomilehto, J., Schwarz, P., Roden, M., Paulweber, M., Stadlmayr, A., Kedenko, L., Katsilambros, N., Makrilakis, K., Kamenov, Z., Evans, P., Gilis-Januszewska, A., Lalic, K., Jotic, A., Djordevic, P., Dimitrijevic-Sreckovic, V., Hühmer, U., Kulzer, B., Puhl, S., Lee-Barkey, Y., AlKerwi, A., Abraham, C., Hardeman, W., Acosta, T., Adler, M., AlKerwi, A., Barengo, N., Barengo, R., Boavida, J., Charlesworth, K., Christov, V., Claussen, B., Cos, X., Cosson, E., Deceukelier, S., Dimitrijevic-Sreckovic, V., Djordjevic, P., Evans, P., Felton, A.-M., Fischer, M., Gabriel-Sanchez, R., Gilis-Januszewska, A., Goldfracht, M., Gomez, J., Greaves, C., Hall, M., Handke, U., Hauner, H., Herbst, J., Hermanns, N., Herrebrugh, L., Huber, C., Hühmer, U., Huttunen, J., Jotic, A., Kamenov, Z., Karadeniz, S., Katsilambros, N., Khalangot, M., Kissimova-Skarbek, K., Köhler, D., Kopp, V., Kronsbein, P., Kulzer, B., Kyne-Grzebalski, D., Lalic, K., Lalic, N., Landgraf, R., Lee-Barkey, Y., Liatis, S., Lindström, J., Makrilakis, K., McIntosh, C., McKee, M., Mesquita, A., Misina, D., Muylle, F., Neumann, A., Paiva, A., Pajunen, P., Paulweber, B., Peltonen, M., Perrenoud, L., Pfeiffer, A., Pölönen, A., Puhl, S., Raposo, F., Reinehr, T., Rissanen, A., Robinson, C., Roden, M., Rothe, U., Saaristo, T., Scholl, J., Schwarz, P., Sheppard, K., Spiers, S., Stemper, T., Stratmann, B., Szendroedi, J., Szybinski, Z., Tankova, T., Telle-Hjellset, V., Terry, G., Tolks, D., Toti, F., Tuomilehto, J., Undeutsch, A., Valadas, C., Valensi, P., Velickiene, D., Vermunt, P., Weiss, R., Wens, J., Yilmaz, T.: A European evidence-based guideline for the prevention of type 2 diabetes. Horm. Metab. Res. 42, S3–S36 (2010). CrossRefPubMedGoogle Scholar
  16. 16.
    Pan, X.-R., Li, G.-W., Hu, Y.-H., Wang, J.-X., An, Z.-X., Hu, Z.-X., Lin, J., Xiao, J.Z., Cao, H.-B., Liu, P.-A., Jiang, X.-G., Jiang, Y.-Y., Wang, J.-P., Zheng, H., Zhang, H., Bennett, P.H., Howard, B.: V: effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. Diabetes Care 20, 537–544 (1997)CrossRefGoogle Scholar
  17. 17.
    Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., Salminen, V., Aunola, S., Cepaitis, Z., Moltchanov, V., Hakumäki, M., Mannelin, M., Martikkala, V., Sundvall, J., Uusitupa, M.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 344, 1343–1350 (2001). CrossRefPubMedGoogle Scholar
  18. 18.
    Gill, J.M.R., Cooper, A.R.: Physical activity and prevention of type 2 diabetes mellitus. Sport. Med. 38, 807–824 (2008)CrossRefGoogle Scholar
  19. 19.
    Diabetes Prevention Program Reasearch: The10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention. Diabetes Care 35, 723–730 (2012). CrossRefGoogle Scholar
  20. 20.
    Diabetes Prevention Program Research Group: Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 3, 866–875 (2015). CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Howard, B.V., Van Horn, L., Hsia, J., Manson, J.E., Stefanick, M.L., Wassertheil-Smoller, S., Kuller, L.H., LaCroix, A.Z., Langer, R.D., Lasser, N.L., Lewis, C.E., Limacher, M.C., Margolis, K.L., Mysiw, W.J., Ockene, J.K., Parker, L.M., Perri, M.G., Phillips, L., Prentice, R.L., Robbins, J., Rossouw, J.E., Sarto, G.E., Schatz, I.J., Snetselaar, L.G., Stevens, V.J., Tinker, L.F., Trevisan, M., Vitolins, M.Z., Anderson, G.L., Assaf, A.R., Bassford, T., Beresford, S.A.A., Black, H.R., Brunner, R.L., Brzyski, R.G., Caan, B., Chlebowski, R.T., Gass, M., Granek, I., Greenland, P., Hays, J., Heber, D., Heiss, G., Hendrix, S.L., Hubbell, F.A., Johnson, K.C., Kotchen, J.M.: Low-fat dietary pattern and risk of cardiovascular disease. JAMA 295, 655 (2006). CrossRefPubMedGoogle Scholar
  22. 22.
    Hooper, L., Martin, N., Abdelhamid, A.: Davey Smith, G.: Reduction in saturated fat intake for cardiovascular disease. In: Hooper, L. (ed.) Cochrane Database of Systematic Reviews, p. CD011737. Wiley, Chichester (2015)Google Scholar
  23. 23.
    Stevens, V.J., Obarzanek, E., Cook, N.R., Lee, I.M., Appel, L.J., Smith West, D., Milas, N.C., Mattfeldt-Beman, M., Belden, L., Bragg, C., Millstone, M., Raczynski, J., Brewer, A., Singh, B., Cohen, J.: Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann. Intern. Med. 134, 1–11 (2001)CrossRefGoogle Scholar
  24. 24.
    Löllgen, H.: Primärprävention kardialer Erkrankungen: Stellenwert der körperlichen Aktivität. Dtsch. Arztebl. 100, A987–A996 (2003)Google Scholar
  25. 25.
    Sofi, F., Capalbo, A., Cesari, F., Abbate, R., Gensini, G.F.: Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur. J. Cardiovasc. Prev. Rehabil. 15, 247–257 (2008). CrossRefPubMedGoogle Scholar
  26. 26.
    Weinstein, A.R., Sesso, H.D., Lee, I.-M., Rexrode, K.M., Cook, N.R., Manson, J.E., Buring, J.E., Gaziano, J.M.: The joint effects of physical activity and body mass index on coronary heart disease risk in women. Arch. Intern. Med. 168, 884 (2008). CrossRefPubMedGoogle Scholar
  27. 27.
    Heran, B.S., Chen, J.M.H., Ebrahim, S., Moxham, T., Oldridge, N., Rees, K., Thompson, D.R., Taylor, R.S.: Exercise-based cardiac rehabilitation for coronary heart disease. In: Taylor, R.S. (ed.) Cochrane Database of Systematic Reviews, p. CD001800. Wiley, Chichester (2011)Google Scholar
  28. 28.
    Jee, S.H., Suh, I., Kim, I.S., Appel, L.J.: Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. JAMA 282, 2149–2155 (1999)CrossRefGoogle Scholar
  29. 29.
    Wendel-Vos, G., Schuit, A., Feskens, E.: Physical activity and stroke. A meta-analysis of observational data. Int. J. 33, 787–798 (2004)Google Scholar
  30. 30.
    Chiuve, S.E., Rexrode, K.M., Spiegelman, D., Logroscino, G., Manson, J.E., Rimm, E.B.: Primary prevention of stroke by healthy lifestyle. Circulation 118, 947–954 (2008). CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Andreas, S., Batra, A., Behr, J., Berck, H., Chenot, J.F., Gillissen, A., Hering, T., Herth, F., Meierjürgen, R., Mühlig, S., Nowak, D., Pfeifer, M., Raupach, T., Schultz, K., Sitter, H., Worth, H.: Tabakentwöhnung bei COPD: S3 leitlinie herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie. 62, 255–272 (2008). CrossRefPubMedGoogle Scholar
  32. 32.
    Goeckejan, G., Sitter, H., Thomas, M., Branscheid, D., Al, E.: Praevention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms—Interdisziplinäre S3-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Krebsgesellschaft. Pneumologie. 64, e1–e164 (2010). CrossRefGoogle Scholar
  33. 33.
    Neusser, S., Krauth, C., Hussein, R., Bitzer, E.M.: Clinical effectiveness and cost-effectiveness of fissure sealants in children and adolescents with a high caries risk. GMS Health Technol. Assess. 10, 1–9 (2014). CrossRefGoogle Scholar
  34. 34.
    Taylor, F., Huffman, M.D., Macedo, A.F., Moore, T.H.M., Burke, M., Davey Smith, G., Ward, K., Ebrahim, S.: Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst. Rev. (2013). CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Hewitson, P., Glasziou, P., Watson, E., Towler, B., Irwig, L.: Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am. J. Gastroenterol. 103, 1541–1549 (2008). CrossRefPubMedGoogle Scholar
  36. 36.
    Atkin, W.S., Edwards, R., Kralj-Hans, I., Wooldrage, K., Hart, A.R., Northover, J.M., Parkin, D.M., Wardle, J., Duffy, S.W., Cuzick, J.: Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375, 1624–1633 (2010). CrossRefPubMedGoogle Scholar
  37. 37.
    Nishihara, R., Wu, K., Lochhead, P., Morikawa, T., Liao, X., Qian, Z.R., Inamura, K., Kim, S.A., Kuchiba, A., Yamauchi, M., Imamura, Y., Willett, W.C., Rosner, B.A., Fuchs, C.S., Giovannucci, E., Ogino, S., Chan, A.T.: Long-term colorectal-cancer incidence and mortality after lower endoscopy. N. Engl. J. Med. 369, 1095–1105 (2013). CrossRefPubMedGoogle Scholar
  38. 38.
    Hüppe, D., Hartmann, H., Felten, G., Kemen, M., Tannapfel, A., Gillessen, A., Katalinic, A.: Effectiveness of screening colonoscopy in a community-based study. Z. Gastroenterol. 46, 193–200 (2008). CrossRefPubMedGoogle Scholar
  39. 39.
    Breitbart, E.W., Waldmann, A., Nolte, S., Capellaro, M., Greinert, R., Volkmer, B., Katalinic, A.: Systematic skin cancer screening in Northern Germany. J. Am. Acad. Dermatol. 66, 201–211 (2012). CrossRefPubMedGoogle Scholar
  40. 40.
  41. 41.
    Otto, S.J., Fracheboud, J., Looman, C.W., Broeders, M.J., Boer, R., Hendriks, J.H., Verbeek, A.L., de Koning, H.J.: Initiation of population-base mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review. Lancet 361, 1411–1417 (2003). CrossRefPubMedGoogle Scholar
  42. 42.
    Health Council of the Netherlands: Population screening for breast cancer: expectations and developments. Den Haag (2014). ISBN 978-94-6281-011-2.
  43. 43.
    Nyström, L., Andersson, I., Bjurstam, N., Frisell, J., Nordenskjöld, B., Rutqvist, L.E.: Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 359, 909–919 (2002). CrossRefPubMedGoogle Scholar
  44. 44.
    Duffy, S.W., Tabár, L., Chen, H.-H., Holmqvist, M., Yen, M.-F., Abdsalah, S., Epstein, B., Frodis, E., Ljungberg, E., Hedborg-Melander, C., Sundbom, A., Tholin, M., Wiege, M., Åkerlund, A., Wu, H.-M., Tung, T.-S., Chiu, Y.-H., Chiu, C.-P., Huang, C.-C., Smith, R.A., Rosén, M., Stenbeck, M., Holmberg, L.: The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties. Cancer 95, 458–469 (2002). CrossRefPubMedGoogle Scholar
  45. 45.
    Gotzsche, P.C., Jorgensen, K.J.: Screening for breast cancer with mammography. Cochrane Database Syst. Rev. 6, CD001877 (2013). CrossRefGoogle Scholar
  46. 46.
    World Health Organization: WHO position paper on mammography screening. WHO, Geneva (2014)Google Scholar
  47. 47.
    Deutsche Krebshilfe, Deutsche Krebsgesellschaft: Ihr Krebsrisiko—Sind sie gefährdet., Bonn (2015)Google Scholar
  48. 48.
    Schröder, F.H., Hugosson, J., Roobol, M.J., Tammela, T.L.J., Zappa, M., Nelen, V., Kwiatkowski, M., Lujan, M., Määttänen, L., Lilja, H., Denis, L.J., Recker, F., Paez, A., Bangma, C.H., Carlsson, S., Puliti, D., Villers, A., Rebillard, X., Hakama, M., Stenman, U.H., Kujala, P., Taari, K., Aus, G., Huber, A., Van Der Kwast, T.H., Van Schaik, R.H.N., De Koning, H.J., Moss, S.M., Auvinen, A.: Screening and prostate cancer mortality: results of the European randomised study of screening for prostate cancer (ERSPC) at 13 years of follow-up. Lancet 384, 2027–2035 (2014). CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    GKV-Spitzenverband: Kennzahlen der gesetzlichen Krankenversicherung., Berlin (2016). Accessed 9 Aug 2016
  50. 50.
    Bundesversicherungsamt: Festlegung der zu berücksichtigenden Krankheiten für das Ausgleichsjahr 2014 nach § 31 Abs. 4 Satz 1 RSAV., Bonn (2013). Accessed 9 Aug 2016
  51. 51.
    Bundesversicherungsamt: So funktioniert der neue Risikostrukturausgleich im Gesundheitsfonds., Bonn (2008). Accessed 27 July 2016
  52. 52.
    Bödeker, W.: Morbi-RSA und Prävention: Passt das zusammen? Die BKK 12, 634–641 (2010)Google Scholar
  53. 53.
    Bödeker, W., Moebus, S.: Normen- und Anreizkonflikte für die gesetzlichen Krankenkassen in Gesundheitsförderung und Prävention. Das Gesundheitswes. 77, 397–404 (2015). CrossRefGoogle Scholar
  54. 54.
    Monopolkommission: Stand und Perspektiven des Wettbewerbs im deutschen Krankenversicherungssystem., Bonn (2017). Accessed 11 May 2018
  55. 55.
    Bundesversicherungsamt: Festlegung der im morbiditätsorientierten Risikostrukturausgleich zu berücksichtigenden Krankheiten durch das Bundesversicherungsamt., Bonn (2008)Google Scholar
  56. 56.
    Stock, S., Schmidt, H., Büscher, G., Gerber, A., Drabik, A., Graf, C., Lüngen, M., Stollenwerk, B.B., Forde, I., Raine, R., Szecsenyi, J., Rosemann, T., Joos, S., Peters-Klimm, F., Miksch, A., Schmidt, H., Wörz, M., Busse, R., Stock, S., Stollenwerk, B.B., Klever-Deichert, G., Redaelli, M., Büscher, G., Graf, C., Al, E., Schmidt, H., Blöß, T., Bödeker, W., Friedel, H., Friedrichs, M., Dreier, M., Linger, H., Schmidt, H., Bäscher, G., Gerber, A., Drabik, A., Graf, C., Längen, M., Stollenwerk, B.B.: Financial incentives in the German Statutory Health Insurance: new findings, new questions. Health Policy (New York). 96, 51–56 (2010). CrossRefGoogle Scholar
  57. 57.
    Bundesversicherungsamt: Festlegungen zur Krankheitsauswahl 2017., Bonn (2016). Accessed 29 Mar 2017
  58. 58.
    Drösler, S., Garbe, E., Hasford, J., Schubert, I., Ulrich, V., van de Ven, W.P.M.M., Wambach, A., Wasem, J., Wille, E.: Sondergutachten zu den Wirkungen des morbiditätsorientierten Risikostrukturausgleichs., Bonn (2017). Accessed 11 May 2018
  59. 59.
    Drösler, S., Hasford, J., Kurth, B.-M., Schaefer, M., Wasem, J., Wille, E.: Evaluationsbericht zum Jahresausgleich 2009 im Risikostrukturausgleich (2011). Accessed 2 Aug 2016
  60. 60.
    Abadie, A.: Semiparametric difference-in-differences estimators. Rev. Econ. Stud. 72, 1–19 (2005). CrossRefGoogle Scholar
  61. 61.
    Austin, P.C.: Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat. Med. 28, 3083–3107 (2009). CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Cohen, J.: Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates Inc., Hillsdale (1988)Google Scholar
  63. 63.
    Stock, S., Stollenwerk, B., Klever-Deichert, G., Redaelli, M., Büscher, G., Graf, C., Möhlendick, K., Mai, J., Gerber, A., Lüngen, M., Lauterbach, K.W.: Preliminary analysis of short term financial implications of a prevention bonus program: first results from the German statutory health insurance. Int. J. Public Health. 53, 78–86 (2008). CrossRefPubMedGoogle Scholar
  64. 64.
    Augurzky, B., Reichert, A., Schmidt, C.: The effect of a bonus program for preventive health behavior on health expenditures. Ruhr Econ. Pap. 373, 1–36 (2012). CrossRefGoogle Scholar
  65. 65.
    Bödeker, W., Friedrichs, M., Friedel, H.: Ökonomischer Nutzen von Bonusprogrammen für die Inanspruchnahme von Früherkennungs- und Präventionsmaßnahmen. Gesundheitswesen. 70, A38 (2008). CrossRefGoogle Scholar
  66. 66.
    Plate, F., Demme, S.: Reformoptionen zum Risikostrukturausgleich - Kühler Kopf und klarer Blick gefragt! Welt der Krankenversicherung. 7–8, 172–175 (2016)Google Scholar
  67. 67.
    Welch, H.G., Black, W.C.: Overdiagnosis in cancer. J. Natl Cancer Inst. 102, 605–613 (2010). CrossRefPubMedGoogle Scholar
  68. 68.
    Schöffski, O., von der Graf Schulenburg, J.-M. (eds.): Gesundheitsökonomische Evaluationen. Springer, Berlin (2012)Google Scholar
  69. 69.
    Bundesministerium für Gesundheit: Entwurf eines Gesetzes für eine faire Kassenwahl in der gesetzlichen Krankenversicherung, Accessed 7 May 2019

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.WIG2 Scientific Institute for Health Economics and Health System ResearchLeipzigGermany

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