Christopher T. Erb

Home Institution
University of Illinois at Urbana-Champaign

Host Institution(s)
European Center for Comparative Government and Public Policy (Humboldt University, Technical University & Freie University)
Mentors: Prof. Dr. Klaus-Dirk Henke (ECCGPP), Prof. Dr. Robert F. Rich (UIUC)

E-Mail:
cerb@uiuc.edu

Research Topic
see Abstract
Personal Reactions to the German Experience
This was a wonderful opportunity for me to meet and work with German faculty members and my student counterparts in Berlin. Unfortunately, my German friends' English was so good that I was not able to practice my limited German skills, and my speaking ability did not improve very much while I was there. I appreciated seeing the similarities and the differences between the American and German academic environments, and I look forward to future collaboration with my colleagues at both the European Centre for Comparative Government and Public Policy and at Charite Medical School.
Greatest Difficulties Encountered
After settling into my apartment and learning my way around the Berlin bus and subway system, there were really no difficulties. I did miss the late-night bus on a few occasions, which made for a long walk home from the office at 1 o'clock in the morning! The short duration of my stay in Berlin made it difficult for me to develop a strong working relationship with my colleagues there, but I have been pleased to stay in contact with them and continue working on related projects since my return to the U.S.
Helpful Hints for Future Students
Be flexible, expect the unexpected, get to know people, and have fun. And definitely take advantage of being in the company of bright, hard-working, and well-known colleagues. I had as many interest-ing personal conversations as I did professional ones. Also, remember that grocery stores close early in Berlin and aren't open at all on Sundays. So if you want to eat, plan ahead!!

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Abstracts on Research Topics
Project I: Should Germany Look to the U.S. for Solutions to Its Health Care Financing Woes?
Authors:
Christopher T. Erb, Robert F. Rich
Institution:
European Center for Comparative Government and Public Policy & University of Illinois at Urbana-Champaign
Abstract:
Rising costs of health care throughout Europe, especially in Germany, are forcing policymakers to look for new alternatives to the current system. They have begun to explore strategies that have been employed in the United States, Australia and elsewhere for many years, including managed care-like tools, utilization review and prospective payment systems. These changes bring the German model closer to the U.S. model, and make the comparison of their respective systems more relevant than they have ever been. The extent to which these health reform initiatives will be successful in Germany depends on a number of political, economic, and cultural factors. This study describes the historical development of and the issues raised by the export of managed care to Germany. I find factors in favor of the successful adoption of managed care in Germany, and as many factors that mitigate against that success. Specifically, a long history and general acceptance of privatization of the health care sector, acknowledged overcapacity of the current system, acceptance of the regulatory structure required to make managed care palatable to the public, and the political will to change the system are all factors that would support the successful adoption of managed care. Concerns about quality of care and restrictions on choice, coupled with existing federal regulations and already low health care prices are factors that will limit the potential success of managed care in Germany. On balance, it is likely that a number of managed care-like techniques will be adopted by the German health care system, but it is unlikely that a fundamental restructuring of that system will be undertaken or that such a system will resemble managed care as it has been known in the U.S. Finally, the study examines the relevance of the reform path in Germany to that of other European countries and finds an additional dilemma posed by the desire to integrate health services across the countries of the European Union.
 
Project II: The Two Faces of Managed Care Regulation And Policy-Making
Authors:
Robert F. Rich, Christopher T. Erb
Institution:
University of Illinois at Urbana-Champaign & European Center for Comparative Government and Public Policy
Abstract:
Over 90 percent of all persons with employer-based health insurance coverage in the United States are enrolled in a managed care plan. Only a decade earlier, fewer than three out of 10 people with health insurance coverage were enrolled in such plans. There has, however, been a strong backlash from consumers and providers against managed care, and it has even been labelled as the "pariah" of the early 21st century. During the same time period, the federal government was encouraging, and in some cases even mandating, the use of managed care principles and practices.
This paper argues that the legal and public policy response to managed care has produced two faces of federal and state policy-making and regulation. These two faces are characterized by support for the implementation of managed care plans through statutes (primarily at the federal level), executive orders, and court decisions on the one hand, and restrictive regulations, legislative initiatives (primarily at the state level) and court decisions which constrain the use of these management practices, on the other hand.
Through empirical examination of statutes, regulations, and court decisions, we document inconsistent and often contradictory actions across levels and branches of government. We find that some of the promise of managed care theory has been realized. Managed care law and public policy has, however, severely limited the effectiveness of managed care theory. We conclude that in the context of the two faces, we cannot determine if our nation's experiment with managed care has succeeded or failed.