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For a better understanding of the following explanations, it is important to point out that volume development is only a partial aspect of the economization of the healthcare system. Other aspects include, among other things, the shortage of material and human resources as well as the premature transfers/discharges of patients. These aspects cannot be directly subordinated to the topic of volume development, but should certainly be taken into account in the planned study. The subtitle of the sub-topic dealt with in this article as “volume development” is not intended to distract from the fact that this is also an explosive medical-ethical and legal problem area. Statistically speaking, examinations and treatments that are not medically indicated have a potential for harm, which is contradicted by the Hippocratic principle of “Primum nil nocere”. This aspect is not discussed here either, but is taken into account in the planned study.
24.01.2013
Against the background of the high number of cancer cases and increasing survival rates, the quality of life of oncological patients is becoming increasingly important. As patients spend shorter periods of time in inpatient facilities, care is increasingly shifting to the outpatient healthcare sector. In the areas of oncological acute medicine as well as post-treatment and rehabilitation, needs-based patient care of varying quality is established and is often integrated into the respective medical treatment concepts. Problems often arise when oncological patients are discharged from inpatient care to outpatient care (Stiel et al. 2009). Both tumor patients and their relatives as well as oncology physicians criticize deficits in the outpatient care of chronically ill tumor patients with regard to adjuvant offers (Herschbach and Mandel 2011; Mehnert et al. 2012; Chambers et al. 2012; Mitchell et al. 2012). The range of support measures available to tumor patients varies locally; in large cities it is generally easier to find a contact point than in structurally weak, mostly rural areas (Stiel et al. 2009). At the same time, comprehensive care, i.e. supporting the patient on a psychological, social and physical level, is recommended for a more favorable course of the tumor disease (Ebbinghaus et al. 2009).
24.01.2013
The introduction of individual contracts in the area of pharmaceuticals enabled the statutory health insurance companies to carry out further structural development, so that the significant savings potential, particularly in the generics market, could be leveraged. Since 2003, health insurance companies have had the option of concluding discount agreements with drug manufacturers. With the legal changes to the GKV-WSG, these contracts have been able to take effect since 2007, since since then pharmacists have also been obliged to sell discounted products unless the prescribing doctor has ruled out substitution.
24.01.2013
More than half of all German citizens over the age of 14 (55 % and therefore 39 million German citizens) own a smartphone (BITKOM 2014), on which an average of up to 23 application programs (apps) are installed (BITKOM 2012). The popularity shown by these numbers offers – also for statutory health insurance companies (GKVn) – new opportunities for reaching target groups in a wide variety of areas, from primary prevention to diabetes management. But if GKVn want to use apps, for example, to fulfill their legal obligation to provide health information and advice (Section 1 SGB V), they have to take a few things into account in the highly sensitive health market.
24.01.2013
The great challenge threatening all developed social systems is demographic development. It has been known for years that the populations in western countries are getting older. In 1950, not even 10 percent of our population was older than 65 years, but in 2025 almost 25 percent of people in Western Europe will be over 65 years old. The age structure will be similar to that in Florida, affectionately called "God's Waiting Room" by the Americans.
24.01.2013
More and more people are using mobile devices such as smartphones, tablets or laptops in their free time. They often use mobile applications, so-called apps. There are apps for a variety of application areas. They are used to search for information, communicate with friends and like-minded people or for entertainment purposes. A growing number of apps are also available in the healthcare sector. In a 2013 study, the IMS Health Institute for Healthcare Informatics examined the status quo of mobile apps in the healthcare sector that were developed specifically for patients. Although the study focuses on the US market, key results can be transferred to other countries. The same applies in Germany as in the USA: The market for patient apps is currently still opaque and weakly regulated. However, due to the special requirements of medical apps, we can already see the beginnings of institutionalized regulation. The first apps have proven their benefits in randomized controlled studies in order to be recommended for use in the ranks of medical devices and thus perhaps soon for reimbursement by health insurance companies.
24.01.2013
Current data from a cross-sectional study of referral patients from 29 general practitioner practices in Germany suggest that around a quarter of referrals take place at the request or request of the patient [1]. Information about such transfers in Germany is mainly based on opinion pieces and experience reports. There are numerous hits on the topic in the open Internet search service Google, especially in health-related public publications and general medical publications (“medical tribune”, “Ärztezeitung”, etc.). Referrals are sometimes issued after this without any doctor-patient contact having taken place [2-3]. Such referrals can lead to oversupply and thus endanger patient safety and strain medical and solidarity-funded resources. Due to the sparse scientific data for the German care system, the aim of this work was to collect experiences and opinions from general practitioners in the context of the active demand from patients explore transfer.
24.01.2013
The severely mentally ill represent an important group in the care of the mentally ill. The blatant lack of care initiated the Psychiatry Enquete 40 years ago, and in fact most of these patients are now cared for in a multi-professional and community-based manner. Nevertheless, the severely mentally ill participate insufficiently or not at all in the current enormous increase in knowledge in the field of psychosocial treatment options. The right to a hospital bed, specialist treatment and access to all available psychopharmacological substances are important but not sufficient for the treatment of the severely mentally ill (Kilian 2014). Access to evidence-based outpatient psychosocial forms of treatment, such as acute treatment at home [home treatment], family-related psychoeducation or supported employment [supported employment], depends to this day on more or less random constellations of laypeople, politicians, those affected, psychiatric... Experts and activities from municipalities, independent organizations or other actors (Kilian 2014). However, in addition to somatic treatments (e.g. psychotropic drugs) and psychotherapeutic interventions, psychosocial therapies are an important and central pillar in the treatment of people with serious mental illnesses. They are mainly aimed at improving the individual possibilities of those affected to live in their social environment and to participate in social life and to enable inclusion.
24.01.2013
“The true profession of the dentist is the preservation of natural teeth, but not the extraction of them and the insertion of artificial ones, which may only take place when the former is no longer possible,” wrote the Leipzig dentist S. Guttmann as early as 1829 (Laurisch 2000 ). This historical definition of dentistry has lost none of its relevance today. However, a paradigm shift from curative to preventative dentistry did not occur in Germany until the mid-1990s, when systematic prophylactic concepts were developed for the entire life span with its age-typical risks (IDZ 1996). The Federal Dental Association (BZÄK), the German Society for Dentistry, Oral and Maxillofacial Medicine (DGZMK) and the National Association of Statutory Health Insurance Dentists (KZBV) jointly took up this concept as a basis for the “new description of a prevention-oriented dental, oral and maxillofacial medicine” and adopted it together with the presentation of legal framework conditions for sustainable implementation in both politics and health care (BZÄK et al. 2004). The Statutory Health Insurance Reform Act in 2000 also led to a realignment of dental treatment guidelines and a realignment of the evaluation standard for dental services (BEMA) according to the model of cause-based and prevention-oriented dentistry. Conservative surgical services were upgraded and at the same time other dental services were devalued.
24.01.2013
In health care, the transitions between inpatient and outpatient sectors pose a particular challenge. From the patient's perspective, the definition of treatment paths and their ongoing optimization along clearly defined interfaces are of essential importance. Accordingly, improving intersectoral communication and collaboration is one of the key goals of many initiatives, measures and associations. In the Baltic Sea Coast health region, HICARE1 – Action Alliance against Multi-Resistant Pathogens (MRE) – aims to implement model regional concepts and support them with health services research. From the perspective of practicing physicians*, this article aims to present challenges and perspectives in the transition of patients with colonization or infection with MRE between sectors. Suggestions for this were given by established colleagues* in the region.