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The statutory health insurance companies are responsible for statutory health insurance (GKV) in Germany. The GKV market is subject to an ongoing, albeit slowing, concentration process with a steadily declining number of providers in the market - the number of health insurance companies has fallen from 950 in 1995 to 110 currently (Federal Health Reporting 2018). The individual health insurance companies are in competition with each other, whereby the majority of their range of services is uniformly designed across all funds via the mandatory GKV service catalogue. The opportunities to stand out from other health insurance companies are very limited. On the service side, this is only possible in the area of the so-called statutory services, via selective contracts with service providers or via additional services. In addition, there is competition over the price in the form of the individual health insurance fund's additional contribution. However, functioning competition in health insurance systems only makes sense if either the conditions for a perfect market are met or balancing mechanisms are implemented that enable functioning competition (cf. also fundamentally Dahl, Lux and Matusiewicz 2012; Matusiewicz 2016).
04.04.2019
Spastic movement disorder (short: SB; synonymous use: spasticity, spasticity) is the name given to the increased health-dependent muscle tension resulting from damage to the central sensorimotor system as well as uncontrolled cloni, spasms and spastic dystonias [1]. The most common cause of SB is a stroke, but multiple sclerosis, traumatic brain injury, a spinal cord lesion or cerebral palsy can also cause so-called spastic paralysis [2]. It is assumed that around 250,000 patients in Germany are affected [3]. Depending on the underlying disease, SB can manifest itself at very different times in the course of the disease [4, 5]. Between 20 and 40% of patients develop SB within the first year after the stroke [3, 6-8]. In patients with multiple sclerosis, approximately half of the patients are affected by SB during the course of their disease [9-11]. It is not uncommon for SB to cause nursing restrictions or dependencies in carrying out activities of daily living and pain, which is accompanied by a significant reduction in the patient's quality of life [12, 13]. If adequate therapy is provided too late or insufficiently, complications such as pain, contractures, skin lesions up to pressure ulcers and significant impairment of activities of daily living can result. To avoid this, it is therefore advisable to initiate management of SB as early as possible, when the first relevant symptoms appear [14].
04.04.2019
The gross value added in the core area of the healthcare industry was around 350 billion euros in 2017. This corresponds to around 12 percent of the gross domestic product. The health sector is not only seen as an important economic sector per se, but also has great economic benefits, as health is seen as the basis for creativity and economic success (BMG 2019a, WHO). In the current discussion, in addition to medical progress and technological achievements, holistic considerations play a role, which lead to better care and can be achieved through the digital networking of the actors. Compared to other European countries, Germany lags behind when it comes to digital offerings, and the welcome initiative to establish a “Global Health Hub” cannot hide this.
04.04.2019
On the occasion of the 2019 SpringSchool of the German Network for Health Services Research in April 2019, Christian Klose (Department "Digitization and Innovation" of the BMG) presented the BMG's roadmap for the development of the Digitization Act (1). This presentation is valuable for several reasons, although the reason for the connection between "digitization and innovation" is not immediately obvious. The value becomes apparent in the description of the determinants to be taken into account*. The Institute of Clinical Economics (ICE) eV is therefore establishing a new working group that deals with the practical application of technical advances in telecommunications in health services research. In this first part of our report, the preliminary work of politics is briefly mentioned and the preliminary work of science is described: The differences between clinical research (KF) and health services research (SR).
04.04.2019
In order to determine the so-called EU reference price, the pharmaceutical company must “report the amount of the actual selling price in other European countries (see Appendix 2, RV) (…) to the extent that the drug in question is offered there” (framework agreement according to Section 130b Paragraph 9 SGB, §3 paragraph (2) SGB V). According to Annex 4 to the RV, in order to “determine the actual sales price weighted according to purchasing power and sales, the company’s actual country-specific sales price must be corrected according to purchasing power and weighted with the sales share of this country in the total sales of the countries to be taken into account. The prices weighted in this way are added together for the comparison countries (framework agreement according to §130b SBG V, Annex 4) and result in the European reference price. However, the arbitration award on the RV of June 21, 2016 (§6 (3) RV) expressly included a regulation in the RV according to which, in justified cases, the turnover weighting can be deviated from and the turnover weighting can instead be carried out approximately using the number of inhabitants. Furthermore, a regulation was included in the RV according to which the contractual partners can deviate from the requirements of Annex 4 No. 2 and No. 3 of the RV, provided that both contractual partners agree or the special features of the specific reimbursement amount agreement or special problems in obtaining data give rise to this. Which methodology appears suitable in which cases and what limitations there are, particularly when it comes to sales weighting, will be discussed below.
04.04.2019
Digital media consumption in western industrialized countries is becoming increasingly widespread. These include the use of computers, online services, smartphones, game consoles and television (Colombani & Videlaine, 2013). All of these digital media make up a large proportion of children and young people's leisure activities (Feierabend, Plankenhorn, Rathgeb & Behrens, 2017a, 2017b). Current study results by Feierabend et al. (2017b) show that 98% of German households are equipped with media devices, usually with a large number of them. At the same time, industrialized countries are increasingly confronted with diseases of affluence such as obesity and overweight, which, in addition to the health impairment, also represent a corresponding financial burden on the health systems (Branca, Nikogosian & Lobstein, 2007; Bader, 2012). Data from the Robert Koch Institute's Child and Adolescent Health Survey (KiGGS) show that in 2008, 15% of 3 to 17-year-old German children and adolescents were overweight. Of these, 6.3% are affected by obesity (Kurth & Schaffrath Rosario, 2010). It is questionable which intervention programs can successfully reduce screen time and whether they actually have an influence on BMI. It is possible that digital media can even be used as an opportunity to exercise and thus have a positive influence on BMI.
04.04.2019
The fact that it is still not known how many people die at home in Germany is chosen as the starting point for the argument in favor of establishing a place of death register. For this purpose, the fundamental importance - with quite heterogeneous objectives and functional purpose - of medical registers is made recognizable. It becomes clear that a register of places of death can be expected to be of great benefit in the short term, particularly for health care planning and health policy, but also in the medium term for the development of the quality of care and for findings for health care research and epidemiological studies in the medium to long term. This applies to all places (milieus, settings) of care. In order to design such a place of death register effectively in terms of content and function, an interdisciplinary working group with transsectoral experience extending beyond palliative care should be brought together. However, the precise - and annually reported - determination of the place of death would be a clear and practically easy to achieve progress.
04.04.2019
To date, there are only a few studies in Germany that examine the reality of iron deficiency/anemia treatment for tumor patients who are undergoing chemotherapy. As part of a European prospective observational study, a prevalence of anemia of 40% (at the start of the study) and 67% (during the course of the study) was measured in over 15,000 tumor patients in 2001/02. In addition, the proportion of patients with anemia therapy and the distribution of the different therapy options were recorded. Of these patients, almost 40% were treated with antianemic preparations, with ESA having the highest proportion among the treatment options (Ludwig et al. 2004). In addition, Steinmetz and colleagues (2016) collected data from almost 1,000 cancer patients in Germany regarding demographic and disease-specific characteristics as well as the distribution of antianemic treatment options. It was found that the majority of patients received blood transfusions to treat the anemia and that both ESA and IV iron played a rather minor role in the treatment. The aim of this cohort study is therefore to investigate the care situation of patients with tumor disease and iron deficiency/anemia therapy. In order to better understand the reality of care in Bavaria (1/7 of those insured by statutory health insurance (GKV) in Germany), patient characteristics and disease-specific therapy options were analyzed using diagnostic and billing data as part of a PHARAO project run by the Bavarian Association of Statutory Health Insurance Physicians (KVB). analyzed.
04.04.2019
It is estimated that around 200,000 people in Germany consume illegal opioid-containing substances each year (Wittchen et al. 2011). This consumption can lead to opioid dependence, a lifelong chronic disease (Wittchen et al. 2011) that is associated with psychiatric and somatic comorbidities such as hepatitis C and HIV. Even if fully synthetic opioids such as the narcotic (BTM) painkillers oxycodone or fentanyl also pose increasing problems with regard to the development of addictive behavior, heroin remains the largest problem area of opioid addiction. Heroin is also considered to be the drug with the highest addictive potential and the highest mortality (Gable 2006). The treatment of opioid addiction usually involves various substitution therapies, in which the illegal opioids are replaced by medically dispensing medication prescribed in accordance with the law and guidelines. With inadequate treatment, which without substitution therapy consists only of detoxification measures, keeping away from the substance, for example in the course of the prison system and rare consultations, the affected patients develop a “revolving door syndrome”, i.e. frequent and regular admissions to hospital, and often die of an overdose. induced respiratory paralysis or secondary comorbidities with severe malnutrition. Substitution therapy enables the decriminalization and stabilization of the patient's psychosocial situation, the systematic treatment of infectious diseases, as well as the influence on the general conditions and targeted long-term therapeutic work on comorbidities such as personality disorders and depression backgrounds. In 2017, there were 78,800 opioid-dependent patients in substitution therapy in Germany (Report on the Substitution Register 2018).
04.04.2019
Depression is one of the most frequently diagnosed mental illnesses both among the general population in Germany and among those insured by AOK Nordost. Previous studies estimate the prevalence of depression in Germany at 8.1% to 10.2%, depending on the respective study design and the underlying data source (Busch et al. 2013; Erhart and von Stillfried 2012). A continuous increase in the prevalence of depression has been observed for years (Thom et al. 2017). Even though treatment rates are constantly increasing, it is estimated that between 35% and 80% of all patients with mental disorders do not receive treatment (Larisch et al. 2013). It can be assumed that this also applies to the treatment of depression to a similar extent. In addition to individual factors as well as social and natural factors, the treatment rate also depends on the availability of service providers (Rommel et al. 2017; Helbich et al. 2018). Accordingly, the current needs planning of psychotherapists is also the subject of controversial discussion (IGES 2016; Peikert et al. 2011).