Abstracts by key term: Integrated care
Multi-case study on dealing with gaps in care
02.04.2025
Two areas must play a key role in the current discussion about efficient networked care between the inpatient and outpatient sectors. The current lowest level of care in the desired hospital reform is considered - the so-called Level Ii of integrated outpatient-inpatient care as well as the area of sector-equivalent care and remuneration in accordance with Section 115 f SGB V. Both areas have the potential to achieve a far-reaching position within the framework of high-quality medical care However, efficient patient care is not considered worthwhile in the current legislative process.
03.10.2023
Heart failure is one of the most medically and health-economically important diseases in Germany (Neumann et al. 2009; Gensichen et al. 2004; Zugck et al. 2010; Willich et al. 2013; Buhr et al. 2007). The prevalence of heart failure is strongly age-dependent, so it can be assumed that the costs for diagnosis and treatment of heart failure will increase in the coming years in view of the aging German population. A large part of the treatment costs for heart failure arise in the inpatient area (Zugck et al. 2010). Against this background, effective integrated care programs have the potential to improve the care of heart failure patients and at the same time prevent decompensations, which are particularly often treated in the inpatient setting. Effective new care programs make it possible to optimize treatment processes, especially in the outpatient area, and to actively involve patients in the treatment concept (Buhr et al. 2007).
29.11.2016
The realignment of care structures to optimize health care across the various service sectors is one of the most important health policy challenges for several decades. Even though medical care in Germany is still characterized by good accessibility and a high level of quality, the frequently discussed challenges in care - keywords include demographic development, multimorbidity, a shortage of doctors and skyrocketing costs - are increasingly threatening to ensure this level of care. Assuming that supply needs can no longer be adequately met in terms of quality and logistics via traditional forms of organization, the structures as a whole must be put to the test and, if necessary, redesigned. In the last ten years in particular, lawmakers have increasingly implemented a variety of laws and reforms to strengthen intersectoral cooperation. With the GKV Health Reform Act in 2000, integrated care was incorporated into German legislation for the first time and reformulated with the GKV Modernization Act of 2004. This formed the basis for selective contractual relationships between health insurance companies and service providers and was instrumental in the increasing importance of cross-sector forms of care. The most recent health care reform as part of the Care Structure Act (VstG), which came into force in January 2012, does not create a breakthrough for cross-sector care models, but it does set certain prerequisites for better interlinking of the service sectors. With the change in § 87 b SGB V, the importance of doctor networks in particular is experiencing a new dynamic. Doctors are significantly more motivated to participate in cooperative models through the possibility of separate remuneration regulations and fee volumes for networked practices.
24.01.2013
The 2013 coalition agreement does not mention the words innovation and progress once in the “Health and Care” section (apart from the new innovation fund), but this aspect is given very broad consideration in the economic policy part of the agreement. The key point is the goal of investing at least 3 % of the gross domestic product in research and development in the future. In order to achieve this, the health care system is also mentioned very prominently in the contract, for which the federal government, for example, plans to promote innovative products and processes in the area of individualized medicine as well as gender and geriatric medicine. However, the question arises as to what effects such research initiatives have on actual care in the health system, i.e. whether the translation into the care context is successful and whether appropriate procedures and assessment methods are available to decide which innovations actually represent medical or social progress should therefore find their way into general care practice at all. This is the subject of health services research, which from a health economics perspective always involves weighing up the identified benefits of a measure and the resources required to implement it. The use of these findings varies greatly depending on the service sector in the healthcare system, which indicates that there is a need to catch up, which will be discussed in this article. The starting point should first be a brief distinction between innovation and progress, in order to then discuss what contribution cost and benefit analyzes can make in this distinction.
24.01.2013
Since the health reform of 2000, the health insurance companies have been entitled to conclude selective contracts with service providers. These are family doctor-centered care contracts in accordance with Section 73b SGB V, contracts for special outpatient care in accordance with Section 73c SGB V and integrated care contracts in accordance with Section 140a SGB V. According to the justification for the 2000 health care reform and the law to strengthen competition, the legislature has followed this In statutory health insurance (GKV Competition Strengthening Act - GKV-WSG), these new regulations promise to intensify competition among health insurance companies and improve the quality and efficiency of care1. Within the framework of these selective contracts, the health insurance companies have a wide range of options to deviate from the collective agreement regulations2. In particular, the health insurance companies are entitled to make new examination and treatment methods part of the coverage in the selective contracts.
24.01.2013
In the German healthcare system, too, the inflexible and almost anti-performance remuneration systems in the outpatient and inpatient sectors are repeatedly criticized. In particular, thanks to the Expert Council for the Assessment of Developments in the Health Care System in 2007 and the activities of the National Association of Statutory Health Insurance Physicians, an increasing dynamic towards P4P can now also be observed in Germany. In this context, the regulations on selective contracts play a special role. It is actually only logical to reward those who perform above average and/or those who have improved significantly. Experience with concepts mainly comes from the USA and Great Britain. The first approach presented here as an example was developed by the Integrated Health Association (IHA), an association of various healthcare players, in California. Another innovative approach in the European discussion is the reorganization of general practitioner remuneration in Great Britain. However, the situation is fundamentally different than in the American models, as this involves the distribution of additional money based on performance. Although there are still no valid evaluation results, the Advisory Council (SVR) found positive results in 21 of 28 studies. Accordingly, P4P is one of the most important developments in the international discussion in recent years.