Original article
The concept of needs-based justice follows the idea of a balanced distribution of goods and services within a society according to objective criteria. Needs-based health care means that - viewed objectively - all citizens receive the care services that are necessary for them from a qualitative and quantitative perspective. Aspects such as effectiveness, quality and cost-effectiveness of and equal access to care services are of particular importance. Where needs are not met, under-supply, over-supply and incorrect supply can result. In its current 2014 report on needs-based care, the Council of Experts examines the question of how the requirement of needs-based care can be further developed in individual service areas. The focus is on current performance and future development opportunities in the supply of pharmaceuticals, the supply of medical devices and medical rehabilitation. The availability of evidence-based knowledge bases is seen as an essential prerequisite for targeted control measures in all three areas.
31.03.2015
In medical practices, patients are increasingly being offered individual health services (IGeL). These services are to be paid for by the insured persons themselves, as they are outside the range of services provided by statutory health insurance. It is important for patients to be well informed about the benefits and possible harm of these medical measures before using an IGeL. It is also important that independent information on IGeL services is available. For this reason, the medical service of the National Association of Statutory Health Insurance Funds has launched the "IGeL Monitor" evaluation portal, in which evaluations of frequently offered IGeL services and further information on the IGeL services are published. In the article, the development of the IGeL market is presented, the information platform IGeL-Monitor and its evaluation results are presented and, based on this, some conclusions are drawn for dealing with IGeL services. Above all, the responsibility of the medical profession when selling IGeL services is emphasized and recommendations are given for patients on how to deal with IGeL offers.
31.03.2015
Intravitreal surgical medication administration (IVOM) has been a standard service for surgical ophthalmologists (ophthalmic surgeons) since 2005. “Macugen” was approved by the European regulatory authority EMA on January 31, 20061. Ranibizumab (“Lucentis”) was approved on February 22, 20072. With the MARINA and ANCHOR approval studies for “Lucentis”, the company Genentech was able to demonstrate that a monthly administration of 0.5 mg ranibizumab leads to visual acuity stabilization in around 95% of patients and that a clinically significant improvement in visual acuity can be achieved in around 34% of patients3,4. This medical breakthrough in the treatment of wet AMD prompted a large number of ophthalmologists in Baden-Württemberg, among others, to offer the treatment of wet AMD with bevacizumab in 2005 in order to help all those patients who would otherwise at least have to wait until the EMA approval and the availability of “Lucentis” in Germany would have suffered irreversible loss of vision. Bevacizumab and ranibizumab have an identical mechanism of action5. This means that a significant proportion of those insured by AOK Baden-Württemberg with wet AMD were already on bevacizumab therapy at the time “Lucentis” was launched on the market in February 2007.
31.03.2015
Politicians attempted to limit increasing expenditure on prescription drugs in statutory health insurance (GKV) with a series of regulatory measures [1]. In addition to the aut-idem regulation, fixed amounts, price moratoria and compulsory discounts, this also includes import promotion according to Section 129 SGB V. Medicines that are available on the market at lower prices in other European countries are bought up commercially by importers and distributed to patients via pharmacies in the country. In addition, there is an import quota, which determines the percentage of imported medicines to be sold by the pharmacist in the pharmaceutical sales [2]. Conceptually, a distinction can be made between parallel-imported and re-imported medicines. The majority of imported goods on the German market are parallel imports. These are medicines that are produced abroad by multinational pharmaceutical companies and imported into Germany by both the manufacturer and the importer [3]. Reimports, on the other hand, are medicines that were produced in Germany and exported to other countries. Re-importers buy them there at a cheaper price and bring them back to Germany [4]. Since new health policy instruments with the aim of limiting expenditure usually do not replace existing ones, but rather expand them, this add-on regulation in the statutory health insurance market leads to an increasingly complex regulatory framework with unclear impact relationships [5-6]. What also seems important from the perspective of health services research is that even unintended negative effects can limit the acceptance of regulatory instruments in practice. The aim of the present study was therefore to qualitatively record the effects of import promotion perceived by the actors.
31.03.2015
In times of demographic change and especially with an increasing proportion of older people and chronic degenerative diseases such as cardiovascular diseases and orthopedic restrictions, the importance of caring for them increases. An important component of the supply chain is prevention services (Pfaff/Schrappe 2011: 19). Patient-relevant endpoints are central cornerstones of patient preferences: patient orientation, along with results orientation and multidisciplinarity/professionalism, is a basic assumption of health care research. We know from working with patients that the quality of results can also be seen in gains in patient care. Measures such as health and quality of life are indicators of such patient-relevant endpoints or gains. It is important to understand “what interests the patient has and how they can be actively involved in decisions” (Neugebauer 2011: 42). In the following, the current state of research on patient preferences and patient-relevant endpoints will be discussed so that the concept can then be transferred to the area of prevention services.
31.03.2015
In the Federal Republic of Germany, the proportion of people over 65 years of age in the total population will increase from 20 % in 2008 to 34 % in 2060 (Federal Statistical Office 2009). Population aging is closely related to the increase in multimorbidity (Saß et al. 2010) and a numerical increase in care in inpatient long-term care facilities (Mennicken / Augurzky 2013). The influence of age on drug consumption is considered to be well documented. In 2011, every GKV insured person aged 65 and over was treated with an average of 3.8 daily doses per day (Coca / Schröder 2012). In 2010, 42 % of Germans over 65 years of age with drug therapy took five or more active ingredients - 5.5 million people are at risk due to polypharmacy (Thürmann et al. 2012). Nursing home residents take an average of 6 different preparations per day (Bartholomeyczik / Wilm 2010).
31.03.2015
Today, care under selective contracts only accounts for around 0.8% of the total expenditure of the statutory health insurance. And from these selective contracts we can only point to a few examples in which selective contract concepts have been transferred to standard care. This is where the innovation fund wants to start: The aim of the fund is to bring care innovations into standard care more quickly and thus further improve patient care. There have been various reasons for the reluctance to develop and implement selective care processes.
31.03.2015
One of the biggest health policy challenges in the coming decades will be the increase in mental illnesses. From 2009 to 2010 alone, health insurance companies recorded an increase in the number of patients requiring treatment of 21.4 % [1]. According to forecasts, the number of patients will continue to increase in the future and, according to the World Health Organization, mental illness will be the second most common widespread disease in 2020 [2]. Consequently, the resulting effects on our healthcare system and, not least, the resulting costs are a central topic of discussion [3]. In Germany e.g. B. According to calculations by the Federal Institute for Occupational Safety and Health, direct costs of 16 billion euros per year (as of 2011) arise due to illnesses from the depressive form [4]. These are expected to double to 32 billion euros by 2030 [4]. One reason for this is, among other things, the increasing number of prescriptions of antidepressants. This increased by 7% between 2010 (1176 DDD = defined daily dose) and 2011 (1257 DDD) [5]. According to the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), this development will continue in the future. This can be explained by the fact that due to demographic change, an increase in older people is to be expected and they are often affected by depression [2].
31.03.2015
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in adults with a high number of unreported cases and increasing prevalence. AF patients have an increased risk of death and illness, for example from strokes. Strokes, on the other hand, are life-threatening events and the most common reason for permanent disability in adulthood. They are associated with considerable medical expenses. The primary and secondary prevention of a stroke in AF is therefore of great importance. It starts with treating the cause of the AF. Oral anticoagulation (OAC) is also an effective medical method to prevent strokes in AF patients. This article is based on findings from the white paper “Stroke Prevention in Atrial Fibrillation” published by the IGES Institute in September 2015 and has been supplemented by information that has been published since then. The care recommendations presented in the white paper are based, among other things, on discussions with experts from the fields of cardiology, neurology, primary care, patient representation and health insurance.
31.03.2015
In the inspiring atmosphere of the Leopoldina, the National Academy of Sciences, the health system partner IVM plus, with the Central German Health Congress that it initiated, has now achieved something for the second time that no longer takes place every day in the mono-centeredness of health policy in Berlin: an interesting congress organize, which addresses the federal and state levels and at these two, but quite different levels, the new regulations in the areas of financing, quality and prevention that emerged as a result of the GKV Care Strengthening Act (GKV-VSG), the new regulations in the area of practice networks, MVZ, cross-sector care and To discuss care and current news from the field of integrated care. And with the participation of over 100 visitors – also from Berlin – in Halle an der Saale, in the middle of Germany.