Managed care in Germany and Switzerland. Two approaches to a common problem.

The point of departure for this contribution is a problem common to all Western healthcare systems, namely the deficiency of their basic building block, the physician-patient relationship. This deficiency opens up a market for complementary agents in healthcare, ranging from medical associations to the central government. While Germany has traditionally put the emphasis on medical associations as the dominant complementary agent (DCA), it is shifting towards the central government. Switzerland, on the other hand, traditionally has relied on the cantonal governments and is now moving towards competing (quasi-) private health insurers that would function as DCAs. Thus, managed care, which is a means through which to reshape the physician-patient relationship, is used quite differently in the 2 countries, with differing expected outcomes and different consequences for the pharmaceutical industry.