Finanzierungsmodelle und Anreizsysteme in der Suchtbehandlung aus deutscher und schweizerischer Perspektive

Abstract

Health policy goals of access, equity, effectiveness and efficiency are linked to the financing of the health care system. Three different categorisations of modes for allocating resources to the providers are usual: variable vs. fixed costs, prospective vs. retrospective payment and different levels of defining lump sums to be reimbursed. The field of substance abuse can additionally be characterised by a mixture of performance-based fees and institutional subventions which makes evaluation of financial incentives almost impossible.
Current changes in the health care system mostly strive for fixed costs, prospective payment and high levels of defining services. The goal of such changes is to limit costs and increase efficiency. However, there have been surprisingly few evaluations with good methodology. For inpatient addiction therapies Switzerland has created a radical change of financing system which should be taken into consideration for future developments.