Purpose: This paper outlines recent fundamental changes in the framework of the German health care system and presents diverse managed care projects and initiatives to standarize patient management using guidelines as a response to these changes.
Main findings: Increasing health care costs and a decline in budget to the statutory health insurances have urged fundamental structural changes in the long-existing German health care system. New legislation introduced competition between health insurers and pushed for pilot projects in managed care. The concepts of some of the new initiatives are presented. All initiatives recognized the need for standardization and disease management, supported by guidelines. The consensus-based guidelines produced by different stakeholders, however, did not prove helpful in patient management. The foundation for an evidence-based, scientifically sound guideline development process has been laid by physicians' organizations.
Conclusions: The most recent changes to the health care system are promising. Their impact on urgently needed changes in the health care system remains to be seen.
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