Health Care systems based on compulsory social insurance alone tend to regulate access to care through control and rationing of human and material resources. As a consequence, motivation for developping and improving therapeutic concepts and procedures is often low. Economic growth and major disposability of financial resources for individual citizens enlarge the field of choice for treatment. Insurance companies and the medical profession are tempted to offer a broad spectrum of treatment options that tends to increase demand and might undermine the quality of indication, thereby causing an increase in complications and in cost for secondary repair which results in spoiling of resources. Measuring and managing quality under these conditions becomes a major concern, especially in mixed economies with both social and private health insurances schemes.
Dear Colleague, thank you very much for your answer which will help me and others to address the question in a well structured way. I am not a pessimist but my personal experience as a clinician is biased by the fact that I have seen some very unpleasant and unfortunate decisions in high risk and therefore complication-prone diabetes patients that have been driven by incentives such as private insurance coverage and networking based on financial criteria alone. I shall be pleased to discuss the subject in more depth in the future.
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