Archive:
What man wouldn't be terrified if they were diagnosed with prostate cancer? However, whether a panic attack is justified depends on the stage of the illness. If bone metastases already appear, life expectancy is low. Tumors in the prostate often spread to the bones. Metastases in other areas of the body also further shorten the lifespan of patients.
24.01.2013
Germany is a rich country, despite the financial crisis and its global consequences. It offers the third most expensive healthcare system in the world - after the USA and the Netherlands1. Nevertheless, people here are not getting any older than in countries with much cheaper systems, such as that in Sweden. Life expectancy at birth was 80.3 years in Germany in 2009; it was higher in 13 European countries, with the highest in Switzerland at 82.3 years2. It is undisputed that progress costs money and innovations do not always have to make sense in the long term - at least at the beginning of the introduction this cannot always be estimated precisely. But here the problem is completely different: It is not the innovations that make the system so expensive, although that is often claimed and is therefore viewed particularly critically, but rather the uncontrolled use of techniques and processes that are often already outdated.
24.01.2013
Improving oral health and intensifying dental care for residents in nursing homes and facilities for the disabled have been the subject of numerous publications (1) and the subject of political initiatives (2) for many years. The Federal Dental Association (BZÄK) and the National Association of Statutory Health Insurance Dentists (KZBV) presented a joint concept in 2010 (3). Almost all authors assume that dental care in these facilities is inadequate. In 2006, the dental service of the Bremen Public Health Department examined the residents of two nursing homes in Bremen and determined the existing need for dental treatment. In over 30% of the residents examined, dental intervention would have been urgently required at that time (4).
24.01.2013
The benefits of statutory health insurance include the prevention, early detection and treatment of illnesses as well as aftercare. All services provided at the expense of the GKV are subject to the cost-effectiveness requirement according to §12 SGB V. The population-oriented distribution of morbidity (approximately 20% of the insured persons tie up around 80% of the services) means, conversely, that approximately 80% of the insured persons actually receive no or only very few services claim. A financing model must take this into account (false price signals) as well as the politically responsible design of an effectiveness-based performance framework. This highlights the need to examine which services should be collectively financed. Medical procedures, products and medicines must be evaluated with regard to their effect (ideally the patient-relevant benefit) in order to include them in the GKV's catalog of services or, if necessary, exclude them.
24.01.2013
Based on the findings from health services research, decisions can be made about benefits in statutory health insurance (GKV) and health care can be improved. Corresponding analyzes are made easier by extensive, reliable and comprehensible data. In order to improve the data situation in Germany, the legislature has created the conditions with the Statutory Health Insurance Care Structure Act to enable data from the morbidity-oriented risk structure adjustment (Morbi-RSA) to also be used for health care research purposes. The German Institute for Medical Documentation and Information (DIMDI) is responsible for preparing and making this data available. In addition to joint self-administration, institutions such as the Federal Joint Committee, the Institute for Quality and Efficiency in Health Care and universities are also authorized to use the data. Whether the intended improvement in health care research can actually be realized must be critically questioned once the data transparency process has begun. The aim of this work is to provide an overview of the new process.
24.01.2013
Biopharmaceuticals are medicines whose active ingredients are obtained as part of a genetic engineering manufacturing process using DNA recombination methods. This manufacturing process is fundamentally different from the synthesis of the active ingredients of chemical drugs. While a chemical synthesis route can be copied identically, the production of drugs from genetically modified organisms is much more complex and results in the active ingredient remaining unique and can only be imitated by another manufacturer, but not reproduced identically. For this reason, copycat biopharmaceuticals are referred to as biosimilars and not as generics, as is the case with chemical medications. In the next few years, a number of biopharmaceuticals will lose their exclusivity, so new biosimilars are likely to complement the biosimilar market, which is currently limited to three drug groups. Even if this can result in cost savings for the payers, it is not possible to validly forecast market developments.
24.01.2013
Clinical registries are increasingly being used to gain knowledge in healthcare (Bertoletti 2013, Lesko 2013, Majek 2013, Veiby 2013, Weiss 2013). Proponents of registers see the advantage of being able to use a well-maintained register to answer a large number of questions that were not yet known at the time the register was initiated. Since regularly and largely complete data sets are collected to record the services provided and to determine the remuneration for services, it is obvious that these data should also be used to answer relevant questions in the benefit assessment of medicines and care management. In addition, this data can be merged with data sets from various sources, e.g. clinical data with data from insurance companies or pharmacies. Skeptics of registers fear that reliable answers cannot always be provided with register data. This argument cannot be dismissed out of hand because it seems possible that a register can, for example, record all the data that is generated during the operation of a technical device. If it is not an isolated technical device but a device in a specific environment, e.g. a car in traffic, which is exposed to complex processes such as the behavior of all road users, it will be considerably more difficult to combine all conceivable variables a priori in one To map registers that ultimately influence the outcome of a process, in the case of a car, reaching the destination. If registers are to be used to describe patient-relevant problems, it can be predicted that the complexity of these bio-psycho-social processes will be so high that the limit of feasibility may be reached. These two perspectives allow us to predict that registries will undoubtedly be useful in health services research, but will also be subject to certain limitations - just like clinical studies. We would therefore like to present theoretical considerations as well as practical experiences on the opportunities and risks of registries and clinical studies and discuss recommendations for their optimized use.
24.01.2013
Medicines are effective and efficient as a form of therapy in the outpatient and inpatient care of patients, provided they are used correctly. However, with increasing therapy options through new drug developments and the simultaneous use of several drugs (polypharmacy), the complexity of drug therapy increases. In particular, chronically ill and multimorbid patients are often treated with several different medications, which increases the risk of adverse drug reactions (ADRs) and drug-related harm. The risk of ADRs in these patients increases due to age-associated changes in pharmacokinetics and pharmacodynamics, in addition to potential drug interactions. Ensuring drug therapy safety (AMTS), especially for chronic patients, represents a particular challenge in drug supply.
24.01.2013
In the report of the Expert Commission for Health Policy of the Heinrich Böll Foundation under the title “How will we be tomorrow? - Paths to more efficiency, quality and humanity in a healthcare system based on solidarity” (Berlin, February 2013), among many other recommendations, a “legal right to information” is called for for patients in order to achieve quality transparency and thus build a more fruitful incentive structure in care. Numerous offers already make this possible today. For example, the white list offers patients the opportunity to search for a nursing home, hospital, doctor or dentist while taking into account the reviews of other patients (www.weisse-liste.de). These are important advances and development directions and the authors expressly welcome the recommendation of the expert commission - the responsible patient is getting closer. But from a psychological point of view, the path to becoming a responsible patient is not guaranteed solely by an appropriate offer. On the receiving end you encounter a complex structure of conditions and factors that can only be approached through an understanding dialogue. In addition, patients are also exposed to other influences, for example the treating doctors, who are often ambivalent towards pre-informed patients (Baumgart 2010).
24.01.2013
The realignment of care structures to optimize health care across the various service sectors is one of the most important health policy challenges for several decades. Even though medical care in Germany is still characterized by good accessibility and a high level of quality, the frequently discussed challenges in care - keywords include demographic development, multimorbidity, a shortage of doctors and skyrocketing costs - are increasingly threatening to ensure this level of care. Assuming that supply needs can no longer be adequately met in terms of quality and logistics via traditional forms of organization, the structures as a whole must be put to the test and, if necessary, redesigned. In the last ten years in particular, lawmakers have increasingly implemented a variety of laws and reforms to strengthen intersectoral cooperation. With the GKV Health Reform Act in 2000, integrated care was incorporated into German legislation for the first time and reformulated with the GKV Modernization Act of 2004. This formed the basis for selective contractual relationships between health insurance companies and service providers and was instrumental in the increasing importance of cross-sector forms of care. The most recent health care reform as part of the Care Structure Act (VstG), which came into force in January 2012, does not create a breakthrough for cross-sector care models, but it does set certain prerequisites for better interlinking of the service sectors. With the change in § 87 b SGB V, the importance of doctor networks in particular is experiencing a new dynamic. Doctors are significantly more motivated to participate in cooperative models through the possibility of separate remuneration regulations and fee volumes for networked practices.