Original article
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.
24.01.2013
The high reserves of the health fund and individual health insurance companies are particularly appealing to lobbyists who advocate “carry on like this” and “more of the same”. Here a patch in favor of the hospitals, there one against the worrying excesses of the different statutory health insurance and private health insurance fees and, not to forget, more money to ensure rural care. The grand coalition is also focusing more on small-scale, incremental reforms, but is opening a new door for innovative, cross-sectoral forms of care with an innovation fund of 300 million euros annually. At the same time, everyone involved knows that, depending on the economic and immigration developments, social service providers will probably face financing problems again from 2016 or 2017, which will require more fundamental reforms and will also increase significantly in the following years. The US innovation economist Clayton Christensen is now formulating the thesis that the actual disruptive innovations or leap innovations are not initiated by politics, but by the supplying economy. He has analyzed innovation processes from various economic sectors for many decades and comes to the conclusion that in all of these areas it is ultimately always possible, according to certain rules, to develop cheaper solutions for an increasing number of consumers. He also analyzed the healthcare system. Here too, the time is ripe for cheaper solutions. In the following, this thesis will be examined and the opportunities and obstacles of breakthrough innovations for the German healthcare system will be weighed up. In healthcare, do we really always have to automatically assume that everything will be more expensive? Or have we gotten ourselves into a system that produces exactly this spiral of inflation, and are there ways to get out of it? What can we learn for the future of our healthcare system from analyzing the innovation patterns of other industries? What role do new business models that are geared towards outcomes rather than quantity of services play? And above all: who will be the market participants who will launch these breakthrough innovations?
24.01.2013
We are in the 4th year of AMNOG. After 38 months, 68 benefit assessments were available. Their results have been and continue to be widely discussed. The topic of price negotiations and the resulting savings potential are also regularly the focus of interest. But what about the effects of the AMNOG processes on everyday care? How have new active ingredients become established on the market depending on their benefit assessment? This article aims to provide the first (cautious) highlights of this – from the perspective of a data service provider.
24.01.2013
The 2013 coalition agreement does not mention the words innovation and progress once in the “Health and Care” section (apart from the new innovation fund), but this aspect is given very broad consideration in the economic policy part of the agreement. The key point is the goal of investing at least 3 % of the gross domestic product in research and development in the future. In order to achieve this, the health care system is also mentioned very prominently in the contract, for which the federal government, for example, plans to promote innovative products and processes in the area of individualized medicine as well as gender and geriatric medicine. However, the question arises as to what effects such research initiatives have on actual care in the health system, i.e. whether the translation into the care context is successful and whether appropriate procedures and assessment methods are available to decide which innovations actually represent medical or social progress should therefore find their way into general care practice at all. This is the subject of health services research, which from a health economics perspective always involves weighing up the identified benefits of a measure and the resources required to implement it. The use of these findings varies greatly depending on the service sector in the healthcare system, which indicates that there is a need to catch up, which will be discussed in this article. The starting point should first be a brief distinction between innovation and progress, in order to then discuss what contribution cost and benefit analyzes can make in this distinction.
24.01.2013
Healthcare innovations aim to make healthcare better and/or more economical. Important starting points and components (without claiming to be exhaustive) are in particular: process optimization with a view to the entire treatment chain, the development of incentive mechanisms for prevention, remuneration models with a focus on the quality of results and not on the quantity and number of services, and active patient participation.
24.01.2013
Since the health reform of 2000, the health insurance companies have been entitled to conclude selective contracts with service providers. These are family doctor-centered care contracts in accordance with Section 73b SGB V, contracts for special outpatient care in accordance with Section 73c SGB V and integrated care contracts in accordance with Section 140a SGB V. According to the justification for the 2000 health care reform and the law to strengthen competition, the legislature has followed this In statutory health insurance (GKV Competition Strengthening Act - GKV-WSG), these new regulations promise to intensify competition among health insurance companies and improve the quality and efficiency of care1. Within the framework of these selective contracts, the health insurance companies have a wide range of options to deviate from the collective agreement regulations2. In particular, the health insurance companies are entitled to make new examination and treatment methods part of the coverage in the selective contracts.
24.01.2013
The positive effects of such occupational therapy interventions, which ideally take place in the home environment, were demonstrated by Graff and colleagues in a study in which not only the everyday skills of the patients improved, but also the quality of life of both dementia patients and caring relatives (8, 9). Another area in which occupational therapy plays a central role in treatment and is listed accordingly in the guidelines is rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis and spondyloarthritis (5). Although positive effects of ergotherapeutic measures have been shown for these diseases, there has been a decreasing trend in prescriptions for rheumatism patients in recent years (10). According to Thieme et al., the reasons for this are: presumably in the budgeting of the remedies combined with the fear of recourse claims by the health insurance companies, in the complexity of the prescription of remedies for those insured by the statutory health insurance companies, in the low appreciation and/or supposedly low evidence of physical therapies and in the long time constant until the noticeable onset of effects (10) . The aim of this article was therefore to present the care profile of patients with occupational therapy prescriptions over a 5-year period. For this purpose, in addition to the age structure, the sex ratio, the living space (city/countryside), the insurance status and the diagnoses of the patients were examined.
24.01.2013
On January 1, 2011, the law to reorganize the pharmaceutical market (AMNOG) came into force. Since the AMNOG came into force, pharmaceutical companies (companies) have had to submit evidence of the additional benefit of the new active ingredient for all drugs with new active ingredients as of the date of market launch. According to the draft bill for AMNOG, one of the objectives of this law was to create “reliable framework conditions for innovation, care for insured persons and job security” (1). The research-based pharmaceutical drug manufacturers have faced the extremely high administrative effort associated with dossier creation. In public statements, IQWiG certifies that the pharmaceutical companies' dossiers are of good quality. After three years of experience with early benefit assessment, the question now arises as to whether AMNOG is an obstacle or an accelerator for innovation.