Health economic evaluation of disease management programs

Abstract

Disease management has become an important element in the improvement of care for persons with chronic illnesses and has become embedded in the health political discussion over recent years. Quite different approaches have been introduced in different countries throughout the world. Accredited disease management programs (DMPs) have been part of the risk structure compensation scheme of the German statutory health insurance since 1 January 2003. This is seen as the first step towards morbidity orientation in the risk structure compensation. DMPs must be evaluated according to German Social Law, especially as to whether the objectives of the programs and the criteria for inclusion of the patients have been met and the quality of care for the patients has been insured. The criteria for evaluation are threefold: medical issues, economic issues, and patients’ subjective quality of life. As an immense quantity of data can be expected, the evaluation of the German DMPs is a huge logistical challenge. The quality of the data has been subjected to only little analysis. The present study focuses on the perspective of the health insurance funds as information about indirect costs is not covered. We discuss the methods of evaluation.