Abstracts by keywords: 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
Health systems in Western societies all face similar challenges: The complexity of health care is increasing, not least due to the demographically-related increase in chronic diseases and multimorbidity (Sin, Askar et al. 2015, Seger and Gaertner 2020) and the advancing specialization and fragmentation in the Medicine. At the same time, there is a glaring shortage of skilled workers, especially in rural regions, which no longer only affects nursing and primary care (German Institute for Applied Nursing Research eV Cologne 2021). Against this background, it is important to make optimal use of the available resources in terms of expertise and service provision. The German Science Council postulated interprofessional collaboration as a strategy for the effective organization of health services in order to be able to master the complex challenges of care in the future (Wissenschaftsrat 2012).
22.07.2022
The high reserves of the health fund and individual health insurance companies are particularly appealing to lobbyists who advocate “carry on like this” and “more of the same”. Here a patch in favor of the hospitals, there one against the worrying excesses of the different statutory health insurance and private health insurance fees and, not to forget, more money to ensure rural care. The grand coalition is also focusing more on small-scale, incremental reforms, but is opening a new door for innovative, cross-sectoral forms of care with an innovation fund of 300 million euros annually. At the same time, everyone involved knows that, depending on the economic and immigration developments, social service providers will probably face financing problems again from 2016 or 2017, which will require more fundamental reforms and will also increase significantly in the following years. The US innovation economist Clayton Christensen is now formulating the thesis that the actual disruptive innovations or leap innovations are not initiated by politics, but by the supplying economy. He has analyzed innovation processes from various economic sectors for many decades and comes to the conclusion that in all of these areas it is ultimately always possible, according to certain rules, to develop cheaper solutions for an increasing number of consumers. He also analyzed the healthcare system. Here too, the time is ripe for cheaper solutions. In the following, this thesis will be examined and the opportunities and obstacles of breakthrough innovations for the German healthcare system will be weighed up. In healthcare, do we really always have to automatically assume that everything will be more expensive? Or have we gotten ourselves into a system that produces exactly this spiral of inflation, and are there ways to get out of it? What can we learn for the future of our healthcare system from analyzing the innovation patterns of other industries? What role do new business models that are geared towards outcomes rather than quantity of services play? And above all: who will be the market participants who will launch these breakthrough innovations?
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
In a previous article (see MVF 06/12) it was theoretically worked out that the Balanced Scorecard (BSC) approach can represent a helpful system for the performance management (PM) of networks in the healthcare system (cf. Pimperl et al. 2012) . This second article focuses on practical feasibility aspects. The aim is to use a case study in individual case design (see, for example, Yin 2003; Eisenhardt 1989) to discuss the development and implementation process in an integrated care system in the German healthcare system. The IV model Gesundes Kinzigtal serves as a case study.
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.