Regular dialysis treatment in Germany: the role of non-profit organisations

Germany's healthcare system is almost entirely premium-funded through compu lsory insurance. Doctors practicing in an outpatient setting are obliged to be members of the "Kassenarztliche Vereinigung" (KV), a kind of union for physicians that has to guarantee adequate medical care for all insured pati ents. Health money is transferred from health insurances to KV and then dis tributed to individual doctors. In 1998, 47,000 patients were treated in Germany by dialysis, 40% in privat ely-owned units, 22% in hospital units and 40% by non-profit facilities. Of these, 35% have diabetes mellitus, 50% of the patients new to dialysis. A total of 92% are treated in ED units, 1.5% at home, and 6.7% by PD. Not-for -profit organisations were founded in 1969 to overcome the shortage of dial ysis facilities. These organisations provide all the non-medical components of dialysis therapy such as machines, disposables, buildings, employment, and management of staff. Nephrologists who are employed by or work with not -for-profit organisations are free to choose the best medical therapy, with no economic bias. Assessment of dialysis quality is not yet official in Ge rmany and it is not clear whether there are different provider associated o utcomes.