Original article
The severely mentally ill represent an important group in the care of the mentally ill. The blatant lack of care initiated the Psychiatry Enquete 40 years ago, and in fact most of these patients are now cared for in a multi-professional and community-based manner. Nevertheless, the severely mentally ill participate insufficiently or not at all in the current enormous increase in knowledge in the field of psychosocial treatment options. The right to a hospital bed, specialist treatment and access to all available psychopharmacological substances are important but not sufficient for the treatment of the severely mentally ill (Kilian 2014). Access to evidence-based outpatient psychosocial forms of treatment, such as acute treatment at home [home treatment], family-related psychoeducation or supported employment [supported employment], depends to this day on more or less random constellations of laypeople, politicians, those affected, psychiatric... Experts and activities from municipalities, independent organizations or other actors (Kilian 2014). However, in addition to somatic treatments (e.g. psychotropic drugs) and psychotherapeutic interventions, psychosocial therapies are an important and central pillar in the treatment of people with serious mental illnesses. They are mainly aimed at improving the individual possibilities of those affected to live in their social environment and to participate in social life and to enable inclusion.
24.01.2013
“The true profession of the dentist is the preservation of natural teeth, but not the extraction of them and the insertion of artificial ones, which may only take place when the former is no longer possible,” wrote the Leipzig dentist S. Guttmann as early as 1829 (Laurisch 2000 ). This historical definition of dentistry has lost none of its relevance today. However, a paradigm shift from curative to preventative dentistry did not occur in Germany until the mid-1990s, when systematic prophylactic concepts were developed for the entire life span with its age-typical risks (IDZ 1996). The Federal Dental Association (BZÄK), the German Society for Dentistry, Oral and Maxillofacial Medicine (DGZMK) and the National Association of Statutory Health Insurance Dentists (KZBV) jointly took up this concept as a basis for the “new description of a prevention-oriented dental, oral and maxillofacial medicine” and adopted it together with the presentation of legal framework conditions for sustainable implementation in both politics and health care (BZÄK et al. 2004). The Statutory Health Insurance Reform Act in 2000 also led to a realignment of dental treatment guidelines and a realignment of the evaluation standard for dental services (BEMA) according to the model of cause-based and prevention-oriented dentistry. Conservative surgical services were upgraded and at the same time other dental services were devalued.
24.01.2013
In health care, the transitions between inpatient and outpatient sectors pose a particular challenge. From the patient's perspective, the definition of treatment paths and their ongoing optimization along clearly defined interfaces are of essential importance. Accordingly, improving intersectoral communication and collaboration is one of the key goals of many initiatives, measures and associations. In the Baltic Sea Coast health region, HICARE1 – Action Alliance against Multi-Resistant Pathogens (MRE) – aims to implement model regional concepts and support them with health services research. From the perspective of practicing physicians*, this article aims to present challenges and perspectives in the transition of patients with colonization or infection with MRE between sectors. Suggestions for this were given by established colleagues* in the region.
24.01.2013
Chronic coronary heart disease (CHD) contributes significantly to mortality, morbidity and loss of quality of life in Germany. Improved therapies and secondary and tertiary drug prevention have contributed to a significant decrease in CHD-related mortality in recent years. The improved survival with CHD and the growing proportion of the older population lead to an increase in the prevalence of the disease and its complications. The present publication is intended to present the morbidity, mortality and prevalence of chronic CHD in Germany and to identify the population groups that are particularly frequently affected by the disease. In addition, aspects of the burden of disease (quality of life, premature mortality and medical costs) are taken into account. Furthermore, gaps in care and potential for optimizing secondary and tertiary prevention for patients with chronic CHD should be identified.
24.01.2013
Integrated supply models are legally and politically supported in Germany. The aim of such models is to contribute to optimizing high-quality and economical patient care by promoting collaboration between service providers within and between the outpatient, acute inpatient, rehabilitation and nursing sectors. Due to the ongoing cost pressure in the German healthcare system, redundancies and frictional losses between the players should be reduced and the burden on social security funds should be relieved. An essential feature of integrated care models is that providers, consumers and cost bearers conclude an individual contract on the basis of selective contracts and on a voluntary basis (see §§140a and b SGB V). In doing so, the legislature has moved away from the collective bargaining system in order to promote greater competition and efficiency in the healthcare system. This opens up the possibility for health insurance companies in particular to select service providers according to their own criteria, negotiate remuneration systems and thus standardize service financing and service delivery under one roof (cf. Amelung 2009, p.6f.). The result is a change in the roles in the traditional triangular structure of insurance company - service provider - patient. The benefit for service providers is to distinguish themselves and professionalize themselves in the competition by offering special treatment programs. Proof of good quality and reputation thus becomes the focus of interest for service providers. Patients benefit from coordinated treatment and quality through, for example, integrated treatment paths (Waehlert/Wagner/Czap 2010) as well as possible bonuses/discounts or other improved conditions from the payers through participation in integrated care models. In return, the patients usually give up their free choice of doctor and undertake to recognize the performance control in the specified contract.
24.01.2013
The expenditure of statutory health insurance on medicines for the treatment of cancer is always the focus of discussion (Neller 2013). A report prepared on behalf of the Federal Ministry of Health on the question of ensuring efficient drug supply in oncology shows that an increase in costs for statutory health insurance is to be expected in this area (Glaeske et al. 2010). The prognosis of future medical costs in the oncological field is also important internationally. Mariotto et al. (2010) considers in particular the demographically related additional costs of cancer treatment in the USA. Yabroff et al. (2011) point to the additional consideration of indirect costs as a result of cancer therapy. These are described by Featherstone et al. (2010) for a consideration of costs in the United Kingdom (UK). The demographically-related annual cost increases between 2008/2010 and 2020 are estimated in these publications at 1.0 % to 2.5 %. Global observations with a focus on the pharmaceutical market and taking new launches into account assume higher annual increases (6.9 % between 2010 and 2016) (Business Insight (2011)), which are also expected in Germany (Höer et al. 2010). The aim of the analysis currently presented is to create a current forecast for the expected development of sales and consumption of statutory health insurance (GKV) for oncological drugs dispensed on an outpatient basis until 2016.
24.01.2013
The scandal surrounding breast implants that ruptured far too easily and were also filled with industrial silicone drew attention in Europe to the safety of high-risk medical products, so that the subsequent scandals were also taken up in public discourse. Now it remains to be seen whether Europe can defend itself against lobby pressure and actually improve safety for patients with the new medical device regulation.
24.01.2013
The so-called multi-criteria decision analysis (MCEA) can be used to support complex technology assessments. Multi-criteria decision analysis procedures have their origins in decision theory or operations research and are used there to make decisions under uncertainty. They assist decision makers in evaluating a finite number of alternative health interventions using a finite number of performance criteria. In addition to conjoint analysis, the elimination and choice translating reality method (ELECTRE) and the multiattribute utility theory (MAUT) (Lootsma/Schujit 1997), the most widely used multi-criteria decision analysis tools include the Analytic Hierarchy Process (AHP).
24.01.2013
Most decision makers, including IQWiG, consider various patient-relevant endpoints to demonstrate the superiority of a therapy over a placebo or a comparator. The question arises: How can contradictory results in different endpoints be interpreted? The problem in benefit assessments with more than one endpoint is the weighting and the subsequent calculation of a key figure for the overall benefit. Without the aggregation of several endpoints into a score/index, the derivation of recommendations or regulatory decisions could be questionable.
24.01.2013
In Germany, medical care is largely financed by contributions from insured persons. This results in the normative and ethical obligation of statutory health insurance to provide the optimum level of health services with maximum benefit for the insured. It is important to reduce waste, use resources efficiently, and all results must be meaningful, especially for patients. The health insurance companies, together with the service providers and the patients, are responsible for achieving these goals and a primarily scientifically based approach (SGB V §§ 2, 12, 35b, 70). The question of what is useful is described, for example, in SGB V § 35b as “improving the state of health, shortening the duration of the illness, extending the lifespan, reducing side effects and improving the quality of life”. This maxim can be found in an identical form in the G-BA's Rules of Procedure, in the Drug Benefit Assessment Ordinance or in the IQWiG method paper for benefit assessment. The statement that the benefit assessment has to be based on “patient-relevant target values” is of particular importance. “In this context, “patient-relevant” should be understood as how a patient feels, can perceive their functions and activities or whether they survive.” (IQWiG 2011, p. 30f)