Implementation of the Preventive Health Care Act at the Level of The Federal States: An Analysis of the Framework Agreements

Abstract

The implementation of the Preventive Health Care Act 2015 requires framework agreements between social insurances and ministries on the state level (Länder). This article analyses the 15 agreements already concluded and provides an overview of similarities and differences between states. We conducted a qualitative content analysis for all 15 agreements. In a first step, we compared the agreements with the model agreement that had informed the negotiations in all states, and identified for each paragraph of the agreement divergent content. In a second step, we compared the divergent content and built subcategories. Third, we classified similarities and differences of each category. For this article, we selected 4 categories: goals and fields of action, committees and regulatory structures, cooperation requirements, cooperation with further actors. All agreements refer to the nationally agreed health goals, some define further, state-specific goals. Furthermore, the agreements provide regulations regarding the goal definition process: some processes only include the subscribers of the agreement, while others involve all relevant stakeholders. New regulatory structures are created in almost all states, but their institutional design and mode of interaction vary highly between state. In 4 states the new structures aim at establishing a dialogue, in 3 states, the goal is to enable coordination, and in 7 states decision-making bodies are set up. Almost all agreements are missing concrete commitments regarding cooperation with other relevant actors on state and local level. Most agreements are very general and their binding character is low. The agreements merely set the framework that now needs to be filled. Hence, evaluating the actual implementation of the agreements will only be possible in a few years.