[Patient management and personal responsibility as part of a statutory health insurance reform: possible approaches for Germany].

Against the backdrop of the precarious financial situation of Germany's statutory health insurance system (GKV), the introduction of a primary care physician system, in which patients first consult a general practitioner and are referred to a specialist if necessary, is currently the subject of intense debate. The aim is better coordination of care and an overall increase of efficiency in the healthcare system.This discussion paper examines the extent to which a primary care physician system can serve as a key component of a fundamental transformation of the healthcare system and identifies the systemic prerequisites for this. In addition to examining other European countries, the paper also discusses experiences from Germany and offers recommendations. It explores a redefinition of personal responsibility as well as the potential of incentive systems for the sustainable establishment of such a system. Bonus programs modeled after successful loyalty schemes could offer an opportunity to design patient management in a way that is effective, accepted, and socially balanced.Patient management is not a matter of discipline, but of system design. A transformation of the statutory health insurance system that integrates patient management and a modern definition of personal responsibility strengthens not only economic efficiency but also solidarity. Patient management and personal responsibility are not moral appeals, but economic necessities. A solidarity-based system remains stable only if it is efficiently organized.