Abstracts by keywords: economic influences
Bundeswehr missions abroad have become a piece of normality (Frank Bötel 2016). But these missions are accompanied by stressful experiences for the soldiers and consequences for their mental health. For example, 2.9 % of the soldiers deployed in 2009 as part of the ISAF mission in Afghanistan met the DSM-IV-TR criteria for post-traumatic stress disorder 12 months after the deployment (Wittchen et al. 2012). This 12-month prevalence is not only significantly higher compared to the control soldiers who are not deployed, but also compared to the rates of the age- and gender-adjusted German general population (Jacobi et al. 2014). In addition, it must be feared that the prevalence rates of mental illness after foreign assignments in general (Kang and Hyams 2005), and that of post-traumatic stress disorder (PTSD) in particular (Brewin et al. 2012) will even increase over the years. A key task that not only the Bundeswehr but all those involved in the care of mentally ill people have to face is how to deal with soldiers of the Bundeswehr who have become mentally ill as a result of the deployment (Holtherm 2014). From the point of view of care, the situation is made more difficult by the fact that soldiers, after leaving the Bundeswehr, switch to the civilian German care system, in which the vast majority of service providers no longer have any personal experience with the military system. So far, however, there are no meaningful scientific findings for Germany either on the subjective need for care or on the objective need for care of former soldiers who are now in the civilian health system.
06.12.2017
With the Cost Containment Act of 1977 and the reform laws that followed in the years that followed, the legislature attempted to ensure high-quality, needs-based and economically efficient provision of medical services to the population. In order to achieve this goal, various instruments have been developed and used; Above all, it was about making the principle of economic efficiency more valid. However, the aforementioned goal was only partially achieved. The approximately 19 million patients who are admitted to inpatient treatment each year are largely well cared for. On the other hand, it is questionable whether the goal of meeting needs is realized in care practice. The increase in the number of inpatients, the number of procedures and the case mix (CM) in hospitals in Germany that has been observed for years was the reason for the development of several studies with the aim of examining the performance development and its causes to evaluate whether the number of medical services provided corresponds to their actual needs1. The studies were published between 2011 and 2014; They explain the volume developments with, among other things, the demographic development of the population, medical and medical-technical progress as well as the resulting new examination and treatment methods (NUB), the insufficient investment financing by the federal states, and various (false) incentives flat-rate G-DRG fee system and the economic interests of hospitals.