Original article
Screening for atrial fibrillation (AF) is recommended in the guidelines of the European Society of Cardiology (ESC) (Hindricks et al. 2020), but is currently not implemented in the form of systematic health programs in Germany. Given demographic changes and the age-dependent occurrence of AF, it is predicted that by 2060 the number of patients aged over 65 years with AF in Europe will increase to over 14 million (Krijthe et al. 2013). Since AF is a relevant risk factor for stroke, screening for AF will become increasingly important. In order to be able to assess the possible effects of introducing guideline-based screening for AF in the German health care context - in particular to avoid long-term health and health economic consequences - a systematic literature search was carried out in 2019. No evidence could be identified from completed, prospective studies in the German health care context that report long-term clinically relevant events after screening for AF. Against this background, a Markov model was developed with which the effects of a screening for AF can be simulated. This model is intended to contribute to the professional public discussion on the detection of AF and the prevention of thromboembolic events and to enable the derivation of adequate measures for better care. For this work, on the one hand, the long-term effects of consistent implementation of the screening measures provided for in the ESC guidelines with regard to the prevention of AF-associated strokes and systemic embolism were examined. On the other hand, the direct health economic implications were considered from the perspective of statutory health insurance (SHI).
29.01.2022
In the cover interview at the start of the year with “Monitor Health Services Research”, Prof. Dr. med. Dr. hc mult. Wolfgang Holzgreve, MBA, explains the role and importance of university hospitals in providing care, especially in the case of Corona. The UKB has treated a total of 1,000 Covid-19 patients so far, currently there are 40. However, the medical director and chairman of the board of the University Hospital Bonn (UKB) gives the all-clear: “Even if the current situation requires strenuous bed and operating theater management on a daily basis, This is everyday life for us and, as a maximum care provider, a constant task.” Despite everything, the UKB was the only one of Germany's 35 university hospitals to record an increase in performance and thus an increase in sales even in the Corona year 2020.
29.01.2022
Karl-Josef Laumann is a veteran of German politics and also of health policy, in which he has been involved in one function or another since the 1990s, when he was still under Federal Health Minister Norbert Blüm. From 2005 to 2010 he was Minister for Labor, Health and Social Affairs for the state of North Rhine-Westphalia for the first time, and he has been so for the second time since 2017. Now, in this legislative period, he has undertaken almost a once-in-a-century project: hospital planning that also deserves the word planning because it translates the previously usual bed bargaining into very differentiated structural planning at the service level. This plan could well be a blueprint for all other federal states, which would change hospital planning throughout Germany; also because – according to Laumann – “it will become clear in five years at the latest that this hospital planning has led to an increase in the quality of care”.
29.01.2022
Since the Medicines Market Reorganization Act (AMNOG) came into force in Germany in 2011, the importance of quality of life data in the benefit assessment of medicines has increased significantly. However, the same also applies to the methodological and conceptual requirements that are placed on their collection and evaluation within the framework of clinical studies. Current problem areas include, among other things, the validation of the measurement instruments designed for the survey, the establishment of accepted relevance thresholds for depicting a clinically significant effect, dealing with insufficient response to questionnaires and concepts for the statistical evaluation of quality of life data in the context of studies with survival time endpoints. Approaches to solving these problems are discussed in a field in which the different interests of academic research, the institutions responsible for evaluations and drug manufacturers come together. A constructive dialogue between all those involved is necessary to create viable concepts.
29.01.2022
“In the medium and long term, however, it is not fiscal but rather structural measures that are needed for an efficient statutory health insurance,” says Johannes Bauernfeind, CEO of AOK Baden-Württemberg, starting an important discussion on future competition in the healthcare system. He further writes: “This insight revives the 'old' discussion about the relationship between state regulation and competitive approaches - and with it the desire for a suitable regulatory framework that, in particular, promotes the quality and efficiency of health care in the best possible way." (1)
29.01.2022
“If you, like us as a large utility company, are concerned with measuring results and methods, the question arises as to which theory is behind the measurement” (Teichert). “Theories are patterns of thought. Theories are ways of understanding problems, ways of approaching things” (Amelung). “A lack of theory is not only a scientific problem, but also a problem for practice” (Pfaff). Three voices, three perspectives on the question of whether health services research has its own theories or - if these have not yet been found and agreed upon - whether it even needs them. At the specialist congress “Dare Theory”, which “Monitor Healthcare Research” held online at the end of last year in cooperation with the Federal Association of Managed Care eV (BMC), it quickly became clear what was already in the quotes from Daniela Teichert, CEO of AOK Nordost, Prof .Dr. Volker Amelung, the chairman of the board of the BMC, and Prof. Dr. It became clear to Holger Pfaff, director of the Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) at the University of Cologne: Health services research needs not just one theory, but many, which exist in abundance in the scientific fields around it. You just have to know them and (want to) use them.
29.01.2022
There is explosive material hidden in the chart collection with the actually quite innocuous title “Status quo and perspectives of the current financial situation of the GKV”. According to the evaluations presented in this chart collection by Prof. Dr. Jürgen Wasem, the holder of the Alfried Krupp von Bohlen and Halbach Endowed Chair for Medical Management at the University of Duisburg-Essen, must take urgent and rapid political action if a sharp increase in additional contribution rates is to be prevented from as early as 2023 in order to avoid the dramatically increasing underfunding of the health fund to prevent. In the BMC web discussion "Current financial situation of the GKV" on January 19, 2022, Wasem opened up a whole range of options for action, from massive increases in additional contributions, enormous increases in tax-financed subsidies to drastic savings in the multi-billion euro range - or a mixture of the same. Wasem: “How do we finance this primary underfunding?”
29.01.2022
Innovative projects - even those with the power to improve the supply landscape - have a difficult time moving from project status to becoming permanent and from there possibly even into standard care. Nobody knows this better than the members of the MSD Health Prize jury. For ten years now, they have been busy trying to find out from the now seemingly countless applications and applications exactly those who - according to co-initiator and juror Dr. Jutta Wendel-Schrief from MSD – “have shown concrete, relevant patient benefit or care processes – ideally without additional costs – are optimized, scalable and economical”. The diverse answers given by the jurors of the MSD Health Prize in this interview show how complex not only the topic area is, but also the requirements for the evaluation and therefore also for the evaluation framework further developed by the jury in 2021.
29.01.2022
Since 2012, health economics issues have been addressed at the University of Duisburg-Essen together with the RWI - Leibniz Institute for Economic Research and other partners. Although there were already a variety of activities in the field of health economics and medical management before CINCH (Competent in Competition and Health) was founded, funding from the Federal Ministry of Education and Research (BMBF) as a national center for health economics has made a significant contribution to this since 2012 that a nationally networked and internationally visible research community in the field of health economics has emerged in the Ruhr area. Research at CINCH1 under the direction of Prof. Dr. Martin Karlsson takes place in seven project groups, led among others by Jun.-Prof. Dr. Katharina Blankart, MBR, and Prof. Dr. Jürgen Wasem. The groups are supported by five associated members. In addition to the RWI and DICE, there are a number of national (e.g. Central Institute for Statutory Health Insurance) and international collaborations (e.g. University of Gothenburg, Monash University, Erasmus University Rotterdam).
29.01.2022
Many topics that have dominated the health policy discussion in Germany and internationally in recent years have been pushed into an almost distant background due to the Corona crisis1. Quality orientation as a central paradigm - who is still aware of the intensity with which the quality offensive was discussed in the middle of the last decade, the patient safety issue was at the forefront, competitive elements such as pay for performance heated up emotions, patient autonomy was held up as the greatest asset and the patient -Reported outcomes were celebrated as cornerstones of quality measurement. Perhaps the most difficult task today is to restore continuity between the present determined by Corona and the themes of this seemingly distant past. Not everything can have been wrong, but on the other hand, it must be recognized that Corona has meant that some of the assumptions and certainties from just a year and a half ago that were considered unchangeable require intensive discussion and addition. The present text can only outline the problem and present a work program based on a few examples. A detailed derivation of the conceptual consequences based on the previous findings from the corona pandemic and the technical and scientific foundations of the quality and safety discussion of the last decades must be reserved for the in-depth discussion in the next few years and will take on a considerably larger scope.ckende Acute diseases such as stroke and myocardial infarction are documented less frequently. The behavioral change that resulted from the implementation of strict hygiene rules may also have led to a “real” decrease in the rates of non-Covid-19 infectious diseases (5,6). In other words, the measures taken to combat the Covid-19 pandemic may also have influenced the spread of other germs that cause respiratory tract infections (AI) and gastrointestinal infections (GI). For this reason, in the present study the authors wanted to investigate the frequency of these AI and GI during the Covid-19 pandemic using data from a large database that includes anonymized treatment information from general practitioners and pediatricians in Germany.