Original article
The federal government's drug commissioner, Ms. Mechthild Dyckmans (FDP), recently called for nicotine replacement therapy for smoking cessation to be reimbursed by statutory health insurance in an interview with the "Berliner Zeitung" at the turn of the year 2013. In her justification, she referred not least to a health economic effect: the savings made by the statutory health insurance through reduced treatment costs for ex-smokers who have successfully given up. In Germany, smoking is the most important preventable health risk for a variety of serious diseases and is also the leading cause of premature mortality. According to the federal government's drug report, the economic damage amounts to around 21 billion euros annually. Among the approaches to avoiding illness and thus the costs of illness, in addition to preventing people from starting to smoke, reducing the smoking rate - both medically and economically - is important. One of the most effective aids in quitting smoking is medical support using nicotine replacement therapy (NET). However, the current framework conditions in the context of the GKV system do not currently allow NET to reimburse costs. This should be critically questioned, taking into account all the criteria used in social law and health policy practice to determine whether medicines can be reimbursed by statutory health insurance.
24.01.2013
Given the challenges of demographic change, the healthcare system is faced with the question of how to allocate resources efficiently and fairly. Only 20% of the insured are responsible for 81.2% of the hospital, medication and doctor expenses of the statutory health insurance (GKV) (1). Approximately 5% of patients account for 50% of utilization (Fig. 1). Almost half of these expenses relate to hospital treatment. In many cases, these are unavoidable and serve to ensure the safety and good quality of treatment for patients. A common reason for claiming benefits is the presence of a chronic illness. The top 10 reasons for hospitalization include diagnoses such as heart failure, angina, hypertension, and type 2 diabetes (1). The acute deterioration of chronic diseases such as diabetes or heart failure often leads to hospitalization. The risk of hospitalization increases significantly if a person has several chronic illnesses at the same time. In order to be able to assess a person's risk, risk prediction models are developed (predictive modeling). The aim of risk models is to avoid (re-)admissions to hospital, to prevent the incurrence of hospital costs and to achieve better health outcomes for the patient with intensive, cheaper medical intervention (2). Risk models can take a lot of information from the service sectors and master data into account in parallel and can be used to predict hospital stays for any reason as well as for specific diseases.
24.01.2013
The current special report from the Expert Council for the Assessment of Developments in the Health Care System (SVR 2012) comprehensively discusses the problems at the interfaces between the outpatient and inpatient sectors. In particular, discharge from hospital is an unprepared admission for vulnerable patients (older age, chronic illness, multimorbidity and/or functional limitations) with numerous risks such as post-hospital health complications, failure to heal, increased psychosocial stress for the patient and their relatives nursing home or readmission to a hospital. The SVR also emphasizes that it has repeatedly pointed out the interface problems as well as implementation and coordination deficits in, among other things, the reports from 2003 and 2007. The fact that “efforts to improve hospital discharge have become even more important” (SVR 2012: 138) is made clear by the current SVR survey. According to this, 78.2% of the hospitals surveyed with more than 50 beds carry out systematic discharge or transfer management and 44.8% have implemented the expert standard discharge management in nursing care (DNQP), with hospitals with a larger number of beds stating significantly more often that they provide these services ( SVR 2012: Tables A-1 and A-2). The SVR also emphasizes that despite this information on the provision of discharge and transition management, “it is not known how successfully this is implemented in practice” (ibid.: 139).
24.01.2013
In a previous article (see MVF 06/12) it was theoretically worked out that the Balanced Scorecard (BSC) approach can represent a helpful system for the performance management (PM) of networks in the healthcare system (cf. Pimperl et al. 2012) . This second article focuses on practical feasibility aspects. The aim is to use a case study in individual case design (see, for example, Yin 2003; Eisenhardt 1989) to discuss the development and implementation process in an integrated care system in the German healthcare system. The IV model Gesundes Kinzigtal serves as a case study.
24.01.2013
In order for the insured to be able to assume their shared responsibility for their health as required by SGB V, they must first acquire the ability to do so. Therefore, a legally guaranteed right to appropriate help such as patient coaching should be introduced for them. The DGbV therefore calls for such a legal entitlement to be anchored in the Social Security Code. Citizen-oriented care management in the healthcare system ultimately benefits everyone: patients, insured persons, service providers, health insurance companies, industry, service providers and, last but not least, the economy.
24.01.2013
In Germany, operations are carried out too quickly and too often. 90 percent of interventions can be avoided if a second expert opinion was sought to clarify the diagnosis before operations. However, the second opinion procedure is just as effective for uncertain diagnoses and for clarifying the correct therapeutic approach. For Deutsche BKK, the procedure is also an important building block in a modern, high-quality and effective care model.
24.01.2013
Interview with Prof. Dr. med. Porzsolt, head of clinical economics at Ulm University Hospital and member of the cancer prevention group European Society Medical Oncology.
24.01.2013
Prostate cancer is the most common type of cancer among men in Germany. According to estimates by the Robert Koch Institute, around 67,600 patients become ill every year. Many of those affected have a localized tumor, for which several treatment strategies are possible. The PREFERE study, presented at a press conference in Berlin, is intended to clarify whether one of these options is superior or inferior. But is the study design suitable for this?
24.01.2013
Polypharmacy is usually referred to as a cumulative prescription of five or more drugs in one period of time. Five active ingredients are often seen as the limit beyond which interactions and side effects can no longer be overlooked. Although polypharmacy is not a new phenomenon, the problem can be expected to worsen given the increasing number of drug prescriptions and the declining number of insured people. This is all the more true as the prescription of potentially inappropriate medication increases with increasing age (cf. Thürmann et al. 2012) and - due to demographic change - in a growing proportion of older patients.
24.01.2013
The relatively simple-sounding topic of “duties to give reasons” is of great legal significance for the Federal Joint Committee (G-BA). The reason: If the sub-statutory norm setter does not meet his obligations to provide reasons, he is threatened with having his norm repealed due to a procedural error. But if, on the other hand, he deals with every theoretically conceivable objection to his decisions in depth and documented, this leads to a significant prolongation of the procedure, which is not in the spirit of the legislature, which is currently appointing the new G-BA boss, Josef Hecken , wanted to bring a little more tension into the process. The pros and cons were discussed at the G-BA's last legal symposium under the title “Duties of the Federal Joint Committee to give reasons”.