Karl Lauterbach

bundestag · health

Veröffentlichung eines von der Friedrich-Ebert-Stiftung, Gesprächskreis Arbeit und Soziales in Auftrag gegebenen Diskussionspapiers. Vorgelegt für die Tagung am 5. Dezember 2001 in Berlin „Mittel- und langfristige Gestaltung des deutschen Gesundheitswesens“. Die Ausführungen und Schlussfolgerungen sind von den Autoren in eigener wissenschaftlicher...

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the Ge...

Surveys among employees are getting more and more relevant in hospital settings since an increase in both (1) efficiency and (2) quality in connection with (3) enhanced patient orientation will only be achieved, if at the same time the employees’ health status and satisfaction are taken into account. Thus, the objective of this study was to compare...

In decision modeling for health economic evaluation, bootstrapping and the Cholesky decomposition method are frequently used to assess parameter uncertainty and to support probabilistic sensitivity analysis. An alternative, Gauss's error propagation law, is rarely known but may be useful in some settings. Bootstrapping, the Cholesky decomposition m...

Coronary artery disease (CAD) is a major cause of death in industrial countries, leading to high health-related costs and decreased quality of life. To develop and validate a decision-analytic model for CAD risk screening in Germany (German Coronary Artery Disease Screening Model). Markov model. Age- and gender-specific cohorts of the German popula...

Efforts have been undertaken to devise and pass an Act of Prevention in Germany. To date, no consensus could be reached with changing political majorities in parliament. Hence, the authors ask the question whether the lack of evidence in prevention and health promotion could also be contributing to this delay. After a systematic search of the liter...

Background and Purpose: Efforts have been undertaken to devise and pass an Act of Prevention in Germany. To date, no consensus could be reached with changing political majorities in parliament. Hence, the authors ask the question whether the lack of evidence in prevention and health promotion could also be contributing to this delay. Methods: After...

Surveys among employees are getting more and more relevant in hospital settings since an increase in both (1) efficiency and (2) quality in connection with (3) enhanced patient orientation will only be achieved, if at the same time the employees' health status and satisfaction are taken into account. Thus, the objective of this study was to compare...

The aim of this study was to quantify and classify errors associated with the repackaging of residents' medications in long-term care facilities in Germany. This was a prospective 8-week study conducted in 3 long-term care facilities. Pill organizers, each of which contained all repackaged solid oral dosage forms of long-term medications for a part...

In Germany the documentation of processes in long-term care is mainly paper-based. Planning, realization and evaluation are not supported in an optimal way. In a preliminary study we evaluated the consequences of the introduction of a computer-based documentation system using handheld devices. We interviewed 16 persons before and after introducing...

The goal of this study was to investigate gender-specific differences in prevalence, healthcare costs, and treatment patterns in the German Statutory Health Insurance (SHI). The study analyzed administrative claims data of over 26 million insured with respect to prevalence and cost of illness of six chronic diseases. Insured were identified using t...

With the implementation of the Health Care Modernization Act in 2004 sickness funds in Germany were given the opportunity to award bonuses to their insured for health-promoting behavior. The aim of this study was to investigate the financial implications of a prevention bonus program from a sickness fund perspective. The investigation was designed...

Health insurance coverage for all citizens is often considered a requisite for reducing disparities in health care accessibility. In Germany, health insurees are covered either by statutory health insurance (SHI) or private health insurance (PHI). Due to a 20%-35% higher reimbursement of physicians for patients with PHI, it is often claimed that pa...

Decisions in healthcare are made against the background of cultural and philosophical definitions of disease, sickness and illness. These concepts or definitions affect both health policy (macro level) and research (meso level), as well as individual encounters between patients and physicians (micro level). It is therefore necessary for evidence-ba...

The prevalence of anti-erythropoietin antibodies in renal patients without clinical evidence of pure red cell aplasia (PRCA) who respond poorly to epoetin is unknown. This study tested for anti-erythropoietin antibodies in hemodialysis patients who were either hypo- or normoresponsive to epoetin treatment. Epoetin hyporesponsiveness (hemoglobin < o...

Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of...

Social healthcare systems in Europe must cope with aging populations and rising costs. For the German social healthcare system, which dates back to the 19th century, this problem is especially apparent, as soaring structural unemployment and the demographic transition of the population threaten the financial basis of the Statutory Health Insurance...

On the surface, the health care systems of Germany and the United States seem to be quite different from each other. However, in both systems, health care financing has close ties to the labor market. Recent changes in Germany's labor market have challenged the traditional employment-based funding of its social health insurance (SHI), to the extent...

Seit Sommer dieses Jahres sind die Eckpunkte der Gesundheitsreform 2006 bekannt. Für Markus Lüngen, Andreas Gerber, Universität zu Köln, und Karl W. Lauterbach, MdB, ist das Modell des Gesundheitsfonds, das im Mittelpunkt der Maßnahmen steht, kein »Erfolgsmodell«. Die möglichen positiven Folgen des Fonds ließen sich, ihrer Meinung nach, auch ohne d...

Reducing overuse of health care services saves costs only if implementation costs are lower than savings from avoided health care services. Predicting the expected net benefit helps policymakers to make a choice among the various overuse problems and components of implementation programs in health care. The goal of this paper is to demonstrate how...

Background and Purpose: Reducing overuse of health care services saves costs only if implementation costs are lower than savings from avoided health care services. Predicting the expected net benefit helps policymakers to make a choice among the various overuse problems and components of implementation programs in health care. The goal of this pape...

Die Analyse beschäftigt sich mit der Möglichkeit der Einführung einer Bürgerversicherung im Bereich der Sozialen und Privaten Pflegeversicherung in Deutschland. Unter einer Bürgerversicherung wird dabei die Einbeziehung der gesamten Bevölkerung in Deutschland sowie die Einbeziehung aller Einkommensarten des Steuerrechts - mit Ausnahme von Mieteinko...

Published cost-effectiveness analyses may overstate the cost-effectiveness ratio of preventive care if they do not explicitly model the costs of the last year of life, which is postponed by prevention. To determine the degree of overestimation, the authors built a statistical model using Medicare expenditure data on survivors and decedents. The mod...

Several strategies have shown to be effective at enhancing the implementation of research findings in daily practice. These implementation strategies improve the delivery of preventive or therapeutic care by successfully educating health professionals. On the other hand, little is known about the costs of these implementation strategies. The goal o...

Retrospective multicenter observational study. To compare the outpatient quality and costs of treating acute back pain in England, Germany, the Netherlands, and Switzerland. No study has yet attempted to compare the quality, costs, and resource utilization of acute back pain treatment in Europe. A total of 130 randomly selected physician practices...

The intended adoption of a global reimbursement system for inpatient care in Germany envisions identical payments for identical treatments at different hospitals. This may lead to losses in some hospitals and may cause problems for the supply with health care facilities in the long run if there a important regional cost differences.Cost and perform...

An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided. MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilit...

While there are many international comparisons on the impact of demographic changes on future healthcare expenditures, there are few such comparisons with regard to the impact of demographic changes on future healthcare funding. The purpose of this article is to analyse the impact of demographic changes on healthcare expenditures and funding in 14...

Evidence-based medicine (EbM) has been practised for about a decade now. Until now, it has generally been accepted that EbM has its roots in medical thinking of mid-19th century France. Due to the startling fact that France never was a centre of EbM, historical tradition was reconsidered. Since EbM has mainly been flourishing in Protestant countrie...

In Germany so far, there exists no evaluation of the relationship between the organization and costs of hospital administrations and hospital characteristics. In a survey of hospital administration costs, structure, and salary level 126 hospitals participated for the years 1998 and 1999. Hospitals of medium size and non-profit ownership show the sm...

Pauschalierende Vergütungen steigern die Effizienz, sind jedoch für ambulante Behandlungen auf Basis deutscher Daten noch nicht entwickelt worden. Der Beitrag zeigt die empirische Ableitung eines Vergütungssystems sowie die Auswirkungen für die hochspezialisierte ambulante Behandlung im Krankenhaus. Zu Grunde liegen 13.929 prospektiv dokumentierten...

Das deutsche Gesundheitswesen steht vor großen Herausforderungen. Hinter diesem lapidaren Satz verbergen sich große Reformnotwendigkeiten, die tiefgreifende Einschnitte in die bestehenden Machtverhältnisse und Strukturen erfordern. Trotz der in allen Bereichen der sozialen Sicherungssysteme andauernden Reformdebatten, werden die sozialen, demograph...

Durch die ersten beiden Stufen der Tabaksteuererhöhung ging der Tabakkonsum insgesamt um 7,7% zurück. Besonders stark war der Rückgang bei den Kindern und Jugendlichen in der Altersgruppe von 12 bis 17 Jahren mit 13%. Dies ist ein großer gesundheitspolitischer Erfolg. Damit wurden die gesundheitspolitischen Ziele durch die ersten beiden Stufen der...

Health services are challenged by increasingly complex medical processes and economic restraints in an aging population. Under these circumstances, medical quality management is developed and increasingly applied to survey especially complex and expensive clinical processes in the sense of controlling. In this process, practicability and relevance...

Increasing medical complexity, centrifugal forces of medical subspecialization and growing economic constraints are the key reasons for the introduction of quality management into routine care processes such as dialysis. Adequate quality assurance and improvement must be implemented in order to supply medical staff, care providers, and patients wit...

The concentration of treatment on a few hospitals is discussed to improve the outcome of care. For the treatment of the breast cancer the distributional effects are evaluated. A systematic literature search in Medline identified six studies dealing with the evidence on the relation between outcome and workload. Using administrative data of a sickne...

No study has yet compared the costs and quality of depression treatment between European countries. The present study aimed to compare the costs and quality of treatment for the first manifestation of an acute major depression in England, Germany and Switzerland. Seventy-four randomly selected physician practices assessed their services for one hyp...

1) To portray the mathematical relationship between the size of an underuse or overuse problem caused by non-compliance of health professionals and the cost-effectiveness of a quality improvement program; 2) to demonstrate the applicability of the models to a real-world problem (underuse and overuse in the treatment of major depression) and to stre...

Quality improvement programs must compete with other health care interventions for limited health care resources. The goal of the research presented here was to develop a model that portrays the mathematical relationship between the size of a quality deficit caused by the noncompliance of health professionals and the cost-effectiveness of a quality...

To date, systematic reviews on the relationship between the volume of specific diagnoses and procedures and patient outcomes have several limitations, including the omission of the most recent publications. To investigate the relationship between hospital and physician volume and patient mortality rate for all diagnoses and interventions in health...

Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart-lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hos...

Despite the prevalence of the terms utilitarianism and utilitarian in the health care and health policy literature, anecdotal evidence suggests that authors are often not fully aware of the diversity of utilitarian theories, their principles, and implications. Further, it seems that authors often categorically reject utilitarianism under the assump...

Many studies have found a significant relationship between the volume of specific diagnoses and procedures and patient outcomes. Often, these studies have cited the "practice-makes-perfect" hypothesis as a potential explanation. However, the expression "practice-makes-perfect" hypothesis is inappropriate in most circumstances. This article suggests...

In Germany, a surge in the number of dialysis patients is expected over the next 10 years. This article aims to: (1) address this trend by developing an evidence-based disease-management program for patients with diabetic nephropathy and; (2) to identify areas for future research on disease management tools. We conducted a systematic search of stud...

The purpose of this paper is to discuss both the fundamental requirements of sound scientific explanations and predictions and common fallacies that occur in explaining and predicting medical problems. To this end, the paper presents Carl Gustav Hempel's 'covering-law' model (1948 and 1962) and reviews some of the criticism of the model. The streng...

To develop a general setting-independent decision-analytical model that determines the costs, effectiveness, and cost-effectiveness of four screening strategies to detect amblyopia or amblyogenic factors in pre-school children and to apply the model in a German setting. The general setting-independent decision-analytical model was developed from th...

Goal: To discuss the costs and cost-effectiveness of quality improvement programs in health care. Cost savings through quality improvement: A quality improvement program saves costs if its investment costs are lower than savings from avoiding medical services. Cost savings are most likely realized if a) an overuse or misuse problem is targeted,...

Unlabelled: Minimum standards as a part of structural quality are often discussed for the sake of improving the quality of medical care. Before implementing obligatory standards, however, the effectiveness of the demands made should be evaluated. The method: Our method was a systematrix review (with an eye to structural quality indicators) of li...

The Australian Refined Diagnosis-Related Groups (AR-DRGs) will be the model for the German DRGs (G-DRGs). Their system to measure severity of illness will be a major point of interest. The most common systems for measuring severity of illness are presented and compared with the AR-DRGs based on criteria regarding applicability. None of the systems...

The goal of this study was to identify and appraise quality and efficiency indicators relevant to hospitals or physicians' practices by performing a systematic literature search. Process indicators were limited to 11 diagnoses and treatments. To appraise the indicators identified, a framework for grading health care recommendations was expanded to...

Background: The Australian Refined Diagnosis-Related Groups (AR-DRGs) will be the model for the German DRGs (G-DRGs). Their system to measure severity of illness will be a major point of interest. Method: The most common systems for measuring severity of illness are presented and compared with the AR-DRGs based on criteria regarding applicability....

Goal: To discuss the costs and cost-effectiveness of quality improvement programs in health care. Cost Savings through Quality Improvement: A quality improvement program saves costs if its investment costs are lower than savings from avoiding medical services. Cost savings are most likely realized if a) an overuse or misuse problem is targeted, b)...

The German Statutory Health Insurance System (Gesetzliche Krankenversicherung) has been in a continuous reform process for the past twenty years. Therefore this economic policy forum is assigned to the question: Health reform: End of the crisis or never-ending crisis? Eckhard Knappe and Stefan Horter argue that this reform process was mostly domina...

Objectives: To present the development process, summarize the content and discuss the implications of the German evidence-based guideline for the treatment of obesity. Design: The target audience and the development process were defined by a multidisciplinary team of experts. A systematic search of the literature was performed to identify releva...

Five screening strategies for amblyopia in different age groups were compared according to a decision-analytical model from the perspective of the health insurance funds. Our findings indicate that the costs per detected case of amblyopia range from about 1200 DM to 3000 DM (613 Euro to 1534 Euro). The two most cost-effective screening strategies w...

Das Bundesministerium für Gesundheit hat Ende März Eckpunkte zur Reform des Risikostrukturausgleichs in der Gesetzlichen Krankenversicherung vorgelegt. Welchen Anforderungen sollte eine solche Reform genügen? --

Decision analysis is used here to establish the most cost-effective strategy for management of potentially operable non-small cell lung cancers (NSCLCs). The strategies compared were conventional staging (strategy A), dedicated systems of positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) in patients with normal-sized (st...

Es wird ein Monte-Carlo-Simulationsmodell vorgestellt, welches die Kosten der koronaren Herzkrankheit aus Sicht der Sozialversicherung über einen Zeitraum von zehn Jahren bestimmt. Es wurde die Differenz zwischen einer Population mit koronarer Herzkrankheit und einer Normalpopulation gebildet, wobei die Population mit koronarer Herzkrankheit der Al...

Management of solitary pulmonary nodules (SPNs) of up to 3 cm was modelled on decision analysis comparing "wait and watch", transthoracic needle biopsy (TNB), exploratory surgery and full-ring dedicated positron emission tomography (PET) using fluorine-18 2-fluorodeoxyglucose (FDG). The incremental cost-effectiveness ratios (ICERs) were calculated...

Hintergrund Nachdem evidenzbasierte Leitlinien international schon seit einigen Jahren eingesetzt werden, gewinnen sie auch in Deutschland zunehmend an Bedeutung. □ Eigene Untersuchungen Am Institut für Gesundheitsökonomie und klinische Epidemiologie in Köln wurde ein weitgehend standardisierter Prozeß für die Entwicklung von evidenzbasierten Leitl...

Patients with angina pectoris have a reduced quality of life because of their symptoms, impaired activity and anxiety. However, there is no consensus on the best method of measuring quality of life. A systematic literature search of randomised controlled trials (RCTs) in angina showed that the most common generic questionnaire was the Nottingham He...

The guidelines for publishing economic evaluations require a statement of the economic importance of the analysis and the viewpoint from which it has been carried out, as well as specification of at least two alternative programmes or interventions, the form of economic evaluation, the outcome measure, the method of costing, the time horizon and ad...

'Ambulante Behandlungen im Krankenhaus werden vom Gesetzgeber zunehmend gefördert. Angesichts möglicher Kostenunterdeckungen und Mengenbudgetierungen ist die Wahl der besten Strategie für Krankenhäuser bisher unklar. Auf der Basis von 16.171 an 6 Hochschulkliniken in Deutschland prospektiv dokumentierten Konsultationen in Ermächtigungsambulanzen (3...

'Background: On July 1, 1997, the German government raised drug copayment by EUR2.60 to EUR 4.60, EUR 5.60 or EUR 6.60 per prescription, depending on package size. The aim of this study was to examine the effects of increased copayments on the demand for drugs and physician visits one year later. Lower income groups and the chronically ill were ana...