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  • Open Access

The Contribution of Managed Care to the Performance of Healthcare Systems — Evidence from Three Countries

Swiss Journal of Economics and Statistics2008144:BF03399263

  • Published:


This paper applies the five standard economic performance criteria to gauge the contribution of Managed Care (MC) to the performance of three healthcare systems, viz. Germany, the Netherlands, and Switzerland. The criteria are (1) matching of consumer preferences, (2) technical efficiency, (3) adaptive capacity, (4) dynamic efficiency, and (5) a rent-free distribution of income that provides incentives for producers to attain criteria (1) through (4). Being insurance-based, the German, Dutch, and Swiss healthcare systems comprise three contractual relationships that can be judged in the light of these criteria. The maximum contribution of MC to the performance of the healthcare system is found for the Netherlands followed by Switzerland. The Independent Practice Associations representing MC in the Netherlands, and the Health Maintenance Organizations representing MC in Switzerland score 15 respectively 6 out of 30 points. By way of contrast, the contribution of the Disease Management Programs to the performance of the German healthcare system remains limited (3 out of 30 points).


  • healthcare expenditure
  • managed care
  • performance
  • principal-agent relationship