Preventive Health Care Act in Germany for Primary Prevention and Health Promotion

Key Contextual Factors

• In Germany, the 16 federal states are responsible for prevention.
• The Federal Ministry of Health is responsible for policy-making at the federal level and for social insurance regulations.
• The Prevention Act has succeeded in creating a uniform framework for health promotion and prevention for the statutory health insurance and other social insurances, which strengthens implementation at all levels (federal, state and local).

Key Components/Steps

• 2015 Establishment of “National Prevention Conference” (NPC) as a committee of key stakeholders. Its members include the social security funds (statutory health and care, accident and pension insurance funds) as well as private health insurance providers. Federal government, states, regional and local authorities as well as other stakeholders are involved in an advisory capacity.
• The mandate of the NPC is to put forward a “National Prevention Strategy” (NPS) and to appraise the strategy as well as its implementation.
• In 2016 and 2018: As part of the NPS “Federal Framework Recommendations” were adopted.
• The Federal Framework Recommendations were transferred into binding “Regional Framework Agreements”. Between 2016 and 2018 contractual agreements were signed for all 16 lander/regions of Germany dedicated to the local/regional implementation of the NPS.
• 2019 Publication of the first “Prevention Report” to evaluate the NPS.
• Statutory health insurance and the long-term care insurance funds are obliged to invest at least €550 million a year in prevention and health promotion activities. Increase of financial support of self-help groups by €30 million.

Main Impacts / Added Value

• Main benefits for individuals and society: improved and more targeted activities in prevention and health promotion.
• At societal level, improved cost-effectiveness due to expected lower number of chronic and mental diseases.

Lessons Learned

• In a federal system formal approaches (e.g. legislation) are effective to implement programmatic public health policy. Involvement of all stakeholders and at all levels of decision making is paramount.

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