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Zuzahlungen werden in der gesundheitspolitischen Debatte regelm\u00e4\u00dfig als Instrument zur Reduktion von Fehlinanspruchnahme diskutiert, zuletzt im Kontext eines Prim\u00e4rarztsystems. Der vorliegende Beitrag analysiert die institutionelle Ausgestaltung und empirische Evidenz finanzieller Steuerungsinstrumente in 4 europ\u00e4ischen Gesundheitssystemen (Deutschland, Niederlande, Frankreich, D\u00e4nemark) und f\u00fchrt die Befunde in einer gesundheits\u00f6konomischen Synthese zusammen. Die Wirksamkeit von Zuzahlungen erweist sich als Funktion dreier ineinandergreifender Bedingungen: der Leistungsart, der verhaltens\u00f6konomischen Ausgestaltung und der institutionellen Architektur. Uniforme Zuzahlungen wirken regressiv und belasten Versicherte mit geringem Einkommen \u00fcberproportional. Eine Wiedereinf\u00fchrung der Praxisgeb\u00fchr in ihrer fr\u00fcheren Form ist auf Basis der internationalen Evidenz nicht zu empfehlen. Sinnvoll erscheint hingegen eine Konstruktion, die Zuzahlungen als gezieltes Lenkungsinstrument an jenen Stellen einsetzt, an denen Fehlinanspruchnahme empirisch festgestellt wird, etwa beim unangemessenen Verlassen eines koordinierten Versorgungspfades. Voraussetzung ist eine Ausgestaltung, die verhaltens\u00f6konomische Effekte und einkommensbezogene Unterschiede ber\u00fccksichtigt. So konzipiert k\u00f6nnen Zuzahlungen zur Verbesserung der Patientensteuerung beitragen, ohne den Zugang zur Regelversorgung zu gef\u00e4hrden.<\/jats:p>","DOI":"10.1007\/s00103-026-04301-y","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:50:57Z","timestamp":1789966257000},"page":"1136-1145","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patientensteuerung aus gesundheits\u00f6konomischer Perspektive: Bedingungen wirksamer Kostenbeteiligung im europ\u00e4ischen Vergleich","Patient steering from a\u00a0health economics perspective: conditions for effective cost-sharing in a\u00a0European comparison"],"prefix":"10.1007","volume":"69","author":[{"given":"Sebastian","family":"B\u00f6hme","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Paas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Konjer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Meyrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Schrey\u00f6gg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"4301_CR1","unstructured":"GKV-Sch\u00e4tzerkreis (2025) GKV-Sch\u00e4tzerkreis sch\u00e4tzt die finanziellen Rahmenbedingungen der gesetzlichen Krankenversicherung f\u00fcr die Jahre 2025 und 2026. https:\/\/www.bundesamtsozialesicherung.de\/fileadmin\/user_upload\/PM_GKV_Schaetzerkreis.pdf. 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