Original article
The serious crisis in the American healthcare system with a significant increase in chronic diseases, massively rising costs with uncertain financing, a lack of coordination with under- or incorrect care, and a lack of quality with the wrong incentive system is a major challenge for the actors involved and politicians. On the other hand, it offers a unique opportunity to make fundamental changes, the urgent need for which is recognized by all those involved. The Patient Protection and Affordable Care Act (PPACA), passed on March 23, 2010 as part of President Obama's healthcare reform, represents the legal basis for a performance- and results-oriented realignment, one of the elements of which is the establishment of accountable care organizations ( ACOs).
02.10.2012
With around six million diagnosed patients, diabetes mellitus is one of the most common chronic diseases in Germany. In addition, the number of diabetics is increasing - regardless of population aging (RKI 2011). In addition, diabetes is one of the most costly diseases. In statutory health insurance (GKV), a diabetic incurs about twice as high direct treatment costs as a non-diabetic insured person (Köster et al. 2006). Almost 30 percent of all diabetics are treated with insulin (Hauner 2007); These include all type 1 diabetics and those type 2 diabetics for whom the body's own insulin production is no longer sufficient despite lifestyle changes and treatment with oral antidiabetics. When it comes to insulin, a distinction can be made between mixed insulins, short-acting, so-called bolus insulins, and long-acting, so-called basal insulins. The latter include NPH insulin (Neutral Protamine Hagedorn), insulin glargine and insulin detemir. Basal insulin accounts for around 30 percent of the total daily insulin doses prescribed on an outpatient basis and 34 percent of statutory health insurance expenditure on insulin (Mengel 2010; INSIGHT Health 2011). The aim of the study presented here is to compare the costs of three treatment strategies that differ in terms of the basal insulin used. Only diabetics who received at least two prescriptions of either insulin glargine or insulin detemir or NPH insulin at the expense of the statutory health insurance in 2010 are included. The outpatient diabetes-related prescriptions for bolus insulins, antidiabetics, blood sugar test strips, needles and lancets billed via pharmacy computing centers are also taken into account. The prescriptions are valued at pharmacy sales prices (Lauer tax) less the statutory manufacturer discounts in accordance with Section 130a Paragraphs 1, 1a, 3b SGB V.
02.10.2012
In Germany, around 430,000 people develop cancer every year (RKI 2010), and the incidence of cancer is constantly increasing. Improved treatment options lead to a reduction in mortality. At the same time, chronic courses of the disease are increasing. For many people, it is now possible to live longer with their cancer. Psycho-oncology as a clinical and scientific discipline has been concerned with the psychological reaction patterns to cancer and psychological comorbidities of tumor patients for many years. The prevalence of psychological disorders and stress is estimated at around 25 to 30 % in these patients (Mehnert et al. 2006, Zabora et al. 2001, Härter et al. 2001, Reich 2008, Massie 2004, CMP 2007). In the studies, anxiety disorders were found in 1 to 49 %, depressive disorders in 0 to 58%, adjustment disorders in 2 to 52 % and post-traumatic stress disorders in 0 to 35 % of cases (Mehnert et al. 2006). Pain, distress, emotional strain of grief, helplessness and hopelessness as well as impairments in health-related and general quality of life are other common side effects of cancer (Mehnert et al. 2009, Weidner et al. 2006, Stock et al. 2006, Härtl et al . 2011, Stremmel et al. 2010).
02.10.2012
The Defined Daily Dose (DDD) is a theoretical quantity that was developed as an international standard comparison quantity for drug consumption research. It indicates the assumed mean maintenance dose per day in adults for an active ingredient in its main indication. In Germany, the official German version of the ATC classification (Anatomical-Therapeutic-Chemical Classification) including the DDD information is published by the DIMDI (German Institute for Medical Documentation and Information) (DIMDI 2010). This is based on the version of the WHO, which is responsible for creating the internationally standardized ATC/DDD system (Fricke et al. 2011). Both the WHO and the AOK Scientific Institute (WIdO), which in turn publishes the methodology of the ATC classification and DDD determination for Germany, point out that the DDD is a calculated quantity that is not related to the therapeutic or prescribed dose may be confused. For longitudinal drug consumption research, the DDDs must be kept stable and are therefore unsuitable as a basis for decision-making for questions regarding drug reimbursement, pricing and therapy (Fricke et al. 2011).
02.10.2012
The autonomy and self-determination of citizens are fundamental elements of our free state. We assume that life can be mastered on one's own responsibility and that individual goals can be found that guide this. The realization of appropriate life chances requires protective framework regulations from the state and society, which are primarily reflected in the social security system.
02.10.2012
Ten years have passed since the initial discussion of disease management programs (DMPs). It's time to learn from experience and determine whether the DMP model, introduced in 2003 and internationally recognized as a successful German initiative, has truly led to higher quality healthcare in Germany. "Are DMPs worthwhile?" asks Prof. Dr. Reinhold Roski, editor of the scientific journal "Monitor Versorgungsforschung" (MVF), which is organizing the conference "10 Years of DMPs" in cooperation with the Federal Insurance Office (BVA). Roski's questions are: "Are DMPs a successful model for integrated care?" and "What criteria should be used to assess quality, effectiveness, and efficiency?" Fifteen speakers, along with the co-chairs of the conference, Prof. Dr. Gerd Glaeske and Prof. Dr. Dr. Alfred Holzgreve, will provide the answers.
02.10.2012
In an increasingly volatile and fast-moving time, brands are becoming more and more important for consumers - also in their role as health insured people. However, if the brand image created by the company does not match the actual brand identity, dissonances occur with counterproductive effects. An aspect that is becoming more important than ever for statutory health insurance companies (GKVn), among other things due to the resulting market confusion and product diversity.
02.10.2012
In Europe, a disease is considered rare if it affects no more than one in 2,000 EU residents. In total, around 30 million people in Europe suffer from one of around 6,000 to 8,000 different rare diseases, around 4 million of them in Germany alone (Eurordis 2009). The number of those affected varies greatly between the diseases: one of the most well-known rare diseases, cystic fibrosis, affects around 8,000 people in Germany alone (Eurordis 2009), and the disease NBIA - nerve degeneration with iron storage in the brain - is estimated to be only in Germany About 100 patients are known. Anyone who struggles with an illness that hardly affects anyone else encounters special challenges: a lack of knowledge among doctors, nurses and therapists, a lack of treatment options, and geographically widely distributed expertise. The lower the prevalence of the often chronic and progressive multi-organ diseases, the less research is available on treatment and care options.
02.10.2012
HAROW is a study in the field of urological health services research and at the same time the largest study on localized prostate cancer (PCa) in Germany. The name is derived from the first letters of the treatment options applicable to PCa, hormone therapy, active surveillance, radiotherapy, surgery and watchful waiting. HAROW documents the course of the different therapy strategies under everyday conditions. It records medical progress data, information on communication between doctor and patient, side effects and therapy acceptance as well as the costs of treatment under everyday conditions. The special feature is that, for the first time in Germany, defensive strategies such as active surveillance and watchful waiting are included in the treatment comparison. The aim is to record the distribution across the different treatment arms, the resource consumption and benefits as well as the acceptance of the therapies under everyday conditions. The following article presents the concept and structure of the study and shares some of the results evaluated.
02.10.2012
„Es ist richtig, bei der Reform der medizinischen Versorgung deutlich zu machen, dass im Mittelpunkt der Versorgung niemand anderes als die Bürgerinnen und Bürger steht“, hieß es in einer Stellungnahme der Deutschen Gesellschaft für Integrierte Versorgung im Gesundheitswesen e. V. (DGIV) zum vorliegenden Referentenentwurf zum Versorgungsstrukturgesetz (GKV-VSG) des Bundesgesundheitsministeriums. Daher begrüße die Gesellschaft überwiegend den Entwurf. Neben dieser positiven Reaktion stellte die DGIV jedoch auch Nachbesserungsbedarf fest. Prof. Dr. med. Stefan G. Spitzer, Facharzt für Innere Medizin/Kardiologie und Sportmedizin und seit November 2010 Vorsitzender des Vorstandes der DGIV, stand „Monitor Versorgungsforschung“ Rede und Antwort.