Effects of the German 1993 health reform law upon primary care practitioners' individual performance: results from an empirical study in sentinel practices.

An empirical study in Lower Saxony aimed to investigate any changes in primary care physicians' diagnostic and therapeutic strategies as a result of Germany's 1993 health reform act (known as the Gesundheitsstruktur Gesetz or GSG), which included the countrywide implementation of a strict drug budget. A sentinel network consisting of a 37% sample of 350 randomly selected doctors (n = 130, GPs, general internists) was established in Lower Saxony. Four cross sectional surveys, each focussing on one group of health problems, were carried out during 1993. These aimed to show whether sentinel practice networks are suitable for reporting physicians' attitudes towards health care cost containment policies and, secondly, changes in physicians' quantitative and qualitative assessments of the 1993 reform act during its first year of implementation. Participating physicians reported patient consultations (n = 3728). Standardised questionnaires ascertained sociodemographic variables and major reasons for the patients' visit. Data on the diagnoses associated with the patient's main reason for the consultation, the doctor's assessment of the severity of the problem, and diagnostic and treatment strategies were also recorded. The questionnaire focussed on changes in therapy made by the physician together with the reasons for these changes. A number of treatment changes made with regard to cost containment were recorded. During the course of 1993 a decrease in reported changes in treatment was noticed. As expected, some doctors recorded a reduction in successful outcomes of treatment and ascribed this to the reform act. Differences between the four surveys with regard to the influence of the health reform act on the frequency of changes in treatment and the physicians' expectations cannot be explained sufficiently by the physicians' adaptation to the cost containment policies within the year.