THE MANAGEMENT OF CHRONIC DISEASES IN THE NETHERLANDS AND IN GERMANY

Chronic diseases pose significant challenges to health insurance systems. On the one hand, the supply of medical care to patients suffering from chronic diseases is very costly; on the other hand, more and more people are becoming chronically ill, and many of them suffer from diabetes. Against this background, steering mechanisms that address chronic disease management are needed, not only to cope with cost containment, but also to improve quality and to overcome obstructive interfaces of supply structures. This article analyses how these challenges are being dealt with and how the respective chronic diseases - the focus will be on diabetes - are managed in the Netherlands and in Germany. The approaches taken in each of these countries present examples of how structures for political and legal steering have been established within health care systems that are subject to frequent reform. Each approach is assessed by analysing the priority given to either regulatory or competitive elements, and particular reference will be made to (subordinated) implementation structures, contracts or models.