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Original article

How exactly does a health insurance company have to provide information?

"We didn't use it." This is the succinct conclusion reached by the majority of health insurance funds regarding the implementation of Section 25b of the German Social Code (SGB V) in the current MVF survey (1). The SBK has so far seen no reason to invoke the legal basis. Techniker Krankenkasse, one of the driving forces behind the German Health Data Use Act (GDNG), has also only identified a single measure. The MVF survey has been running since February – even before the BfDI circular of April 1, 2025, on the information obligations of health and long-term care insurance funds regarding the right of objection, which significantly tightened the requirements for the funds and spoke of a "multiplicity of information measures" and "conceivable building blocks."

02.06.2025
Many concrete recommendations for action

„Es ist eine Orientierungshilfe auf dem Weg zu einer besseren Versorgungssituation“, erklärte Prof. Dr. Stephan Baldus, Direktor der Medizinischen Klinik III für Innere Medizin am Universitätsklinikum Köln, der als Schirmherr an der Vorstellung des eben erschienenen neuen Weißbuchs „Prävention von Herz-Kreislauf-Erkrankungen – Versorgungssituation in Deutschland“ (1) teilnahm. Das Weißbuch, finanziert von Novo Nordisk Pharma, verfolgt „einen wissenschaftlichen Ansatz, ist neutral und produktunabhängig“, wie Hans-Holger Bleß (_fbeta) bei der Präsentation der Ergebnisse des Weißbuchs betonte. Der Dritte im Bunde der Buchpräsentation, Prof. Dr. Ulrich Laufs, Klinik und Poliklinik für Kardiologie am Universitätsklinikum Leipzig und Co-Autor des Weißbuchs, gab einen Hinweis darauf, warum sich Novo Nordisk hier engagiert. Er sagte: „Wir müssen die kardiovaskuläre Inflammation als bedeutsamen Risikofaktor stärker in den Blick nehmen. Hier liegt eine große Chance für eine effektivere Behandlung von kardiovaskulären Erkrankungen.“

02.06.2025
Legal implications of the stratification of the insured clientele according to Section 25b SGB V – requirements for patient information and AI use

Health and long-term care insurance funds can evaluate insured persons' data. Various information obligations can arise from the data evaluation. These obligations arise first when a specific health risk to the insured person is identified. This requires that there is a sufficient probability of health damage. Health and long-term care insurance funds must also provide information if their data evaluation reveals that there is a possibility (not probability) of illness or the need for care in the foreseeable future that arises from the individual (life) circumstances of an insured person. Whether these thresholds are reached in each case is ultimately determined by medical science and health services research. Health and long-term care insurance funds must always be able to provide a comprehensible justification for how they arrived at their results and why they made which information decisions. These legal requirements limit the use of artificial intelligence to the extent and as long as they cannot make their procedures and results transparent and comprehensible. Violations of these requirements can result in claims for information and damages against the health or long-term care insurance funds.

02.06.2025
AOK digital heart health: promoting and inhibiting factors of digital preventive interventions

Background: One-third of the German population is affected by high blood pressure. Digital preventive interventions are particularly suitable for promoting a healthy lifestyle. The model project "AOK Heart Health Digital" was initiated to support patients with hypertension. Methods: The aim of the study (with three survey waves) was to identify factors from the participants' perspective that promote or inhibit the (long-term) use of such interventions. Results: Subjective self-management/disease management, general health status, and health literacy improved. Personal counseling, in particular, proved to be beneficial and motivating. Technical and motivational barriers were identified. Conclusion: The results show that personal components can significantly influence the success of digital interventions.

02.06.2025
Drug therapy for migraine in children by pediatricians in Germany – what role do discount agreements play?

Data on the use of drug migraine therapies in children in routine practice are limited. The aim of this study is to analyze and evaluate the prescribing patterns of acute migraine therapies in outpatient pediatric practices in Germany. This retrospective, cross-sectional study includes children aged 2–12 years with a migraine diagnosis diagnosed by one of the 250 participating pediatricians between January 2015 and December 2023. 10.9% of the children aged 2–5 years and 18.3% of the children aged 6–12 years received a prescription for migraine medication. The most frequently prescribed active ingredient was ibuprofen (75.4% and 75.9%, respectively), which is available in various dosage forms. Among children aged 2–5 years who received an ibuprofen prescription, 68.2% received ibuprofen as a suspension, 16.3% as rectal suppositories, and 15.5% as orodispersible tablets. In the 6–12 year age group, suspension (36.3%) was the most frequently prescribed dosage form, followed by orodispersible tablets (31.8%) and solid tablets (29.9%). The proportion of orodispersible tablets was significantly higher among privately insured patients than among publicly insured patients (53.7% vs. 31.0%) and higher in 2015 compared to 2024 (40.5% vs. 24.8%). Orodispersible tablets appear to be the preferred dosage form for children, but they cannot always be prescribed due to discount agreements.

02.06.2025
Video consultations in pediatric emergency services: Case study on technology use and satisfaction

This study addresses the topic of comprehensive healthcare provision through digital health. Using a case study, it examines the use of video consultations for pediatric emergency care in North Rhine-Westphalia. It analyzes technology use and patient satisfaction. Recommendations for optimizing healthcare provision are derived from this.

02.06.2025
Redesign of a care pathway through digital integration

Given the increasing need for care and staff shortages in Germany, innovative digital solutions are needed to optimize collaboration. Current processes for exchanging vital data and medication plans are time-consuming and error-prone, compromising the safety and efficiency of care. The goal of the Docs & Care Network project was to develop standards for structured data exchange and promote seamless digital integration that enables the timely and secure transfer of vital data and medication plans. The change management strategy applied in the project ensures that technical, organizational, and interpersonal aspects of digitalization are specifically addressed and that employees are actively involved. The workshops conducted have enabled process improvements that increase both the quality of patient care and the efficiency of collaboration between nursing staff and general practice.

02.06.2025
“Stronger focus on the methods of study conduct”

Interview with Dr. Thomas Kaiser, Director of the IQWiG

02.04.2025
„Foundation sheet for the further development of health systems”

Interview with Prof. Dr. Oliver Gröne, Chief Scientific Officer and Head of Research at OptiMedis AG

02.04.2025
IGES 2.0: stronger together and further into Europe

IGES Group continues internationalization and becomes part of the athagoras Group

02.04.2025

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