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In order to keep premium rates for Statutory Health Insurance (SHI) stable, German health policy designed several cost‐containment acts since 1989. Within these reform acts budgets for SHI‐expenditures were introduced in 1997, and reimbursement schemes were changed from fee‐for‐service‐payments to capitation and flat rates per case. This article discusses the possible effects of these institutional changes on the quality of health care. It then demonstrates the weaknesses of the regulatory strategy for quality assurance pursued by German health policy. Finally, it outlines a two‐tier strategy based on regulatory and competitive elements to ensure a high quality of care.

Wege zur Sicherung der Qualität im Gesundheitswesen: Theorie und Praxis