Implementing Disease Management Programs for Type 2 Diabetes in Germany

Objectives: The objective of this study is to examine the acceptance of disease management programs (DMPs) for type 2 diabetes among patients as well as physicians in Germany.

Background: DMPs began in the United States in the 1990s. The German government developed interest in DMPs for specific conditions and implemented them nationwide in 2003 for patients with diagnosed type 2 diabetes. The goal was to improve the quality and efficiency of diabetes care nationwide. Participation in the program is voluntary for both patients and physicians.

Methods: Data were systematically collected from the publicly accessible Web sites of the Federal Insurance Agency (Bundesversicherungsamt) and the State Associations of Ambulatory Care Physicians (Kassenaerztliche Vereinigungen). In addition, these agencies were contacted directly by phone to verify the completeness and accuracy of the data.

Results: Since the national implementation of DMPs in Germany, the most dramatic growth in patient enrollment occurred during the first year with a doubling every three months until the 1 million mark was reached in July 2004. Since then the enrollment has shown a slower but steady growth rate, with 1.76 million patients with type 2 diabetes currently enrolled.

About 75 percent of primary care physicians have enrolled in a DMP. However, there are significant regional differences in enrollment rates from state to state.

Conclusions: About one third of all patients with type 2 diabetes and three quarters of all primary care physicians are currently enrolled in a DMP. This implies a high rate of acceptance by both patients and physicians. One of the main reasons for the success of the programs with regard to enrollment has been the passage of risk adjustment legislation, which created an incentive for health insurance companies to enroll patients with chronic conditions, rather than creating disincentives to enrollment. This finding may be of interest to other countries that already have DMPs in place or that are considering the introduction of DMPs into their health care system.

Early reports show an average improvement of glycemic control in enrolled patients, but further studies need to be done to examine whether this leads to an overall improvement in patient outcomes.