Correspondence (reply): In Reply

With regard to the interest in the DMPs, the point of increased time spent on documentation in a general practice setting where time resources are already limited is understandable. However, DMPs indeed provided a financial incentive for health insurances until the end of 2008 due to the integration of the DMPs in the risk adjustment scheme. This changed with the introduction of the morbidity-based risk adjustment scheme (Morbi-RSA) and the elimination of the DMP enrolment as a separate RSA category. In addition, the program cost flat-rate fee for each enrolled insured person fell from €180 in 2009 to €145.68 in 2014 (1). As a result, health insurances were increasingly interested in evaluating the program’s effectiveness. However, evaluations meeting methodological minimum requirements are needed. The analysis of currently available studies provided in our article shows this very clearly. None of the studies included in our review performed an analysis of those participants who dropped out from DMPS—as required by the intention-to-treat principle. Likewise, the DMP routine documentation fails to systematically record data on this patient population. There are various reasons for dropping out, ranging from the termination of membership to a lack of active participation and hospital admission, to death. Detailed information about this is provided in the Quality Assurance Report 2012 DMP in North Rhine where cases of drop-out from the DMPs were analyzed (2). Fullerton et al. (3) analyzed cases of drop-outs where there was no DMP documentation. We agree that these patients will require special attention in further studies on the effectiveness of DMPs and should explicitly be included in future analyses.