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For years, numerous national and international publications have confirmed that in Germany, by international comparison, too few medically necessary operations are performed on an outpatient basis (Brökelmann 2007: 5; Toftgaard/Parmentier 2006: 42-48). Although it is known that some of these deviations can also be explained by different organizational and financial factors in the respective countries, the deviations in some operations are still too clear for these explanations to be used as the sole justification for the differences (Busse/Wörtz 2009: 52 – 54; Oberender & Partner 2010: 26 – 28).
24.02.2012
Health services research is a multidisciplinary scientific discipline with a comparatively young history [1]. The desired goals of this scientific discipline are of great importance for assessing the situation in the healthcare system - possibly with corresponding effects on practice, politics and science. According to Pfaff [2], health services research can be defined as an “interdisciplinary research area that describes and causally explains health care and health care and its framework conditions, as well as evaluates the effectiveness of care structures and processes under everyday conditions”. Particular emphasis should be placed on the analysis of medical questions or issues relating to healthcare in general under everyday conditions, which therefore differs significantly from the classic clinical study. In particular, the field of health services research is divided into different areas that arise from the subject matter of the study (e.g. needs research, quality research, health care epidemiology).
24.02.2012
A significant increase in chronic diseases, massively increasing costs with uncertain financing, a lack of coordination with inadequate or incorrect care, and a lack of quality with the wrong incentive system are major challenges for the actors involved and the politics of the American healthcare system. To counteract this trend, President Obama passed the Patient Protection and Affordable Care Act (PPACA) as part of his healthcare reform. It represents the legal basis for a performance and results-oriented realignment, one of the elements of which is the establishment of accountable care organizations (ACOs). (See MVF 06/11 “Accountable Care Organizations (ACOs) as an innovation in the American healthcare system”).
24.02.2012
The “Integrated Care for Healthy Kinzigtal”, which was launched in 2005, is definitely a flagship project of a different, more modern care concept. A whole series of evaluations of individual intervention programs as well as the results for all insured persons of the participating health insurance companies show that, on the one hand, hospital admissions and the number of prescriptions for unnecessary medication are decreasing, and on the other hand, the contribution margin, for example for the residents of the nursing homes in Kinzigtal, for whom a special care program was started , was already significantly positive in 2010, whereas in 2007 it was almost minus 3,000 euros. “The current results show how quickly integrated care can lead to substantial success, to the benefit of both the insured and the health insurance companies,” emphasizes Helmut Hildebrandt, board member of OptiMedis AG and managing director of Gesundes Kinzigtal GmbH. Hildebrandt sheds light on the success factors of the model he initiated in an interview with “Monitor Healthcare Research”.
24.02.2012
From 2002 to 2005, Birgit Fischer was Minister for Health, Social Affairs, Women and Family in the state of North Rhine-Westphalia, deputy since 2007 and then chairwoman of the board of the Barmer GEK from 2010. Until she took a big step into the industrial side in May 2011 and became CEO of the Association of Research-Based Drug Manufacturers (vfa) as the successor to Cornelia Yzer. This step was polarizing and there was even talk of it being disreputable, probably also because she was seen as a critic of the pharmaceutical industry on the health insurance side. Today, exactly one year later, such criticisms are a thing of the past, also because the trained educator sees herself as a “bridge builder”, as someone who knows and understands the different sides of the health system and is working on a new, common and, above all, sustainable care solution want.
24.02.2012
In der politischen Diskussion um die Zukunft unserer sozialen Sicherungssysteme und besonders unseres Gesundheitssystems ist der Zusammenhang zwischen Demenz und demographischem Wandel unübersehbar. Demographische Veränderungen bewirken einen steilen Anstieg der Anzahl der über 65-Jährigen bei gleichzeitigem Rückgang der Bevölkerung im erwerbsfähigen Alter. Mit dieser Entwicklung steigt auch das Vorkommen altersbedingter Erkrankungen. Dazu gehört z.B. die Demenz, für die das Alter als Hauptrisikofaktor genannt wird. Demenz-erkrankungen stellen daher eine große Herausforderung für die zukünftige gesellschaftliche Entwicklung dar: Betrachtet man aktuelle Erkrankungszahlen, so werden die Brisanz und die Wichtigkeit des Themas deutlich. Für Deutschland wird sich die Anzahl Demenzerkrankter von derzeit über 1,2 Millionen auf 2,5 Millionen im Jahre 2060 mehr als verdoppeln. Dabei ist zu bedenken, dass die Demenz einen erheblichen Aufwand an medizinischer und pflegerischer Betreuung verursacht. Sie wird daher als vermutlich teuerste Erkrankung des höheren Lebensalters bezeichnet. Der World-Alzheimer-Report (2011) spricht aufgrund dieser Entwicklungen von Demenzerkrankungen als der wesentlichen sozialen, gesundheitlichen und ökonomischen Herausforderung des 21. Jahrhunderts, der nur mit einem weiteren Ausbau von Forschung und Versorgungsstrukturen begegnet werden kann.
24.02.2012
In recent years, the use of biotechnologically produced drugs has increased significantly. These active ingredients, which are usually produced through the use of bacteria or cell cultures, are used in a variety of indication areas. Biotechnologically produced active ingredients are used particularly in the treatment of serious diseases such as anemia in kidney disease, rheumatoid arthritis and other systemic diseases as well as various cancers (Roger 2006). One way to save costs in the area of biologicals is to increase the use of so-called “biosimilars”, which can be developed by other manufacturers and brought onto the market after the patent protection of the biological has expired. As part of a model calculation, it was examined how high these expected savings could be by substituting the reference biologicals with biosimilars using the example of selected European countries between 2007 and 2020.
24.02.2012
The complexity of the metabolic disease diabetes mellitus type 2 affects many organs in the body. Accordingly, a positive correlation is often found between the severity of diabetes and the occurrence of other diseases such as neuropathy, peripheral arterial disease (PAOD) and coronary artery disease (CHD) (Bauer T, 2011). CHD means that the coronary arteries that supply the heart muscle with oxygen are narrowed. This constriction is caused by arteriosclerosis, which in turn can arise from hypertension, hyperlipidemia and increased blood sugar levels in diabetes mellitus. In particular, the increased blood sugar damages the vessels and leads to micro- and macroangiopathies. As a result, diabetics are much more likely to develop CHD than non-diabetics (Kannel W, 1979). The risk of coronary heart disease is already increased before the diabetes diagnosis, as the pre-diabetes phase with elevated blood sugar levels exists for a long time before the confirmed diabetes diagnosis (Hu FB, 2002)
24.02.2012
The Federal Joint Committee (G-BA) recommends to the Federal Ministry of Health requirements for the design of disease management programs (DMP) for the statutory ordinance according to § 266 Para. 7 SGB V. The current status of medical science should be taken into account, taking into account evidence-based guidelines or the best available evidence for the respective care sector. The G-BA is also obliged to regularly check the DMP to ensure it is up to date. A last update of the DMP diabetes mellitus type 1 and type 2 was made by regulation in June 2009 (Federal Ministry of Health 2009). In December 2009, the Federal Joint Committee commissioned the Institute for Quality and Efficiency in Health Care (IQWiG) to carry out research for evidence-based guidelines on the subject of type 1 and type 2 diabetes mellitus. The recommendations extracted from the identified guidelines form the basis of the statutory update of the DMP diabetes mellitus.
24.02.2012
Das Geschrei vor Einführung des morbiditätsorientierten Risikostrukturausgleichs (Morbi-RSA) in 2009 war groß. Die höhere Morbidität in der Versichertenstruktur einer Krankenkasse würde nun über Gebühr belohnt, so eine der ständig wiederkehrenden Thesen. Das wäre ein Wettbewerbsnachteil für diejenigen mit vielen gesunden und jungen Versicherten. Empirische Daten als Beweis für diese Behauptungen gab es damals nicht. Seit September 2011 sind die Krankenkassen schlauer. Zu diesem Zeitpunkt und mit einiger Verzögerung veröffentlichte das Bundesgesundheitsministerium den Evaluationsbericht des wissenschaftlichen Beirats im Bundesversicherungsamt (BVA).1 Erstmalig wurde die Wirkungsweise des 2009 eingeführten Morbi-RSA auf der Basis der Daten der gesetzlichen Krankenversicherung (GKV) wissenschaftlich untersucht. Zudem setzte sich das Gutachten mit den Änderungsvorschlägen der Krankenkassen, der Ärzteverbände und weiterer Akteure auseinander und erarbeitete Empfehlungen zur weiteren Vorgehensweise. Die Wissenschaftler bescheinigen dem Morbi-RSA im Vergleich zum früheren Risikostrukturausgleich unterm Strich, dass „die Berücksichtigung der Morbidität der Versicherten zu einer deutlichen Verbesserung bei der Deckung der durchschnittlichen Leistungsausgaben führt.“2 Sie geben aber auch deutliche Hinweise zu notwendigen Korrekturen.