Original article
Medicines are among the most effective therapeutic measures used in the German healthcare system. However, the therapeutic progress that has been achieved in this area is also associated with considerable costs. The challenge for the healthcare system is to allow all patients to participate in this effective measure and in the progress that has been achieved, despite limited financial resources. The pharmaceutical expenditure of the statutory health insurance (GKV) has been rising continuously for years. This increase is only interrupted by legal regulations such as a price moratorium or manufacturer discounts, which usually have a short-term but not lasting effect and are also usually compensated by above-average increases in expenditure after the measures have expired. An expert report commissioned by TK by Prof. Stargard, University of Hamburg, Chair of Health Care Management shows that the end of the price moratorium and the reduction of the manufacturer discount, which has meanwhile increased, will result in additional expenditure of up to 1.4 billion euros for the health insurance companies would have drawn. The increase in drug spending is mainly caused by new drugs.
24.01.2013
The attentive observer of health topics will have come across the term “personalized medicine” disproportionately frequently in recent times. But what exactly is behind it? A superficial fad or an opportunity for a healthcare system groaning under high costs?
24.01.2013
For many observers, our healthcare system is characterized by standstill. Good ideas would not be implemented, citizens and patients would be denied progress, and two-tier medicine would possibly be promoted. This is often attributed to over-regulation, bureaucratic obstacles and mutual blockade by interest groups. On the other hand, there are also those who point out that the range of services on offer is constantly growing, that this growth is not adequately controlled, and that this is essentially a result of uptake induced by the providers. Representatives of this position therefore prefer to discuss the aspect of limiting growth instead of the question of a backlog of innovation according to the motto: “How much more growth should we afford?” These “minus” and “plus” perspectives on the development of the Health care systems usually come face to face suddenly. However, it is noticeable that the position taken is often influenced by the role of the viewer in this system. Representatives of the minus or standstill thesis are primarily assigned to service providers or the healthcare industry, while representatives of the plus or growth thesis are usually assigned to payers and public health-oriented science. What is interesting is that both camps agree that the healthcare system functions irrationally and inefficiently, that it is risky and even sometimes hostile to patients.
24.01.2013
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.