Reinhard Busse

Technische Universität Berlin | TUB · Department of Health Care Management

Introduction The COVID-19 pandemic has exposed weaknesses in health systems of many countries, including those in sub-Saharan Africa. Despite comparatively low rates of COVID-19 admissions and deaths in sub-Saharan Africa, the pandemic still had a significant impact by disrupting health service utilisation (HSU). The aim of this scoping review is t...

Financial risk protection from high costs for care is a main goal of health systems. Health system characteristics typically associated with universal health coverage and financial risk protection, such as financial redistribution between insureds, are inherent to, e.g. social health insurance (SHI) but missing in private health insurance (PHI). Th...

Aims: A substantial fraction of patients undergoing knee arthroplasty (KA) or hip arthroplasty (HA) do not achieve an improvement as high as the minimal clinically important difference (MCID), i.e. do not achieve a meaningful improvement. Using three patient-reported outcome measures (PROMs), our aim was: 1) to assess machine learning (ML), the si...

Importance Although remote patient-reported outcome measure (PROM) monitoring has shown promising results in cancer care, there is a lack of research on PROM monitoring in orthopedics. Objective To determine whether PROM monitoring can improve health outcomes for patients with joint replacement compared with the standard of care. Design, Setting,...

Objectives Medical services whose benefits do not outweigh the costs and potential harm are labelled as low-value care. Reducing low-value care, either by reducing the number of diagnoses leading to the medical service or by reducing the number of prescriptions, shows a growing significance in health economic research.The goal of the IndiQ-Project...

Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation f...

Zusammenfassung Einleitung Der deutschen Krankenhauslandschaft mangelt es an einer gezielten Versorgungssteuerung, was u. a. an der unzureichenden Nutzung von durch die Deutsche Krebsgesellschaft (DKG) zertifizierten Krebszentren zu erkennen ist. So werden allzu viele Patient*innen außerhalb von Krebszentren und damit schlechter behandelt. Um dem z...

Background Segmenting the population into homogenous groups according to their healthcare needs may help to understand the population’s demand for healthcare services and thus support health systems to properly allocate healthcare resources and plan interventions. It may also help to reduce the fragmented provision of healthcare services. The aim o...

Patient reported outcome measures (PROMs) experience an uptake in use for hip (HA) and knee arthroplasty (KA) patients. As they may be used for patient monitoring interventions, it remains unclear whether their use in HA/KA patients is effective, and which patient groups benefit the most. Nonetheless, knowledge about treatment effect heterogeneity...

The Danish hospital landscape has been continuously restructured since the early 2000s. A structural reform reorganized the public sector, and a hospital reform restructured the hospital landscape, closing hospitals and concentrating specialized treatment in so-called super-hospitals. Reforms can generate considerable debate, including in the media...

Zusammenfassung Die Regierungskommission für eine moderne und bedarfsgerechte Krankenhausversorgung hat im Dezember 2022 ihren Reformvorschlag vorgelegt, der aus drei Kernelementen besteht: (1) Krankenhäuser werden in drei einheitlich definierte Krankenhaus-Versorgungsstufen (Level) eingeteilt. (2) Das Leistungsspektrum der einzelnen Krankenhäuser...

Zusammenfassung Der bestehende Fachkräftemangel und der Wettbewerb um Fachkräfte stellen deutsche Krankenhäuser vor die immer größere Herausforderung, qualifiziertes Pflegepersonal zu gewinnen und zu halten. Die Covid-19-Pandemie rückte die Thematik der Arbeitsbedingungen und die Rolle des Gesundheitspersonals in deutschen Krankenhäusern verstärkt...

Zusammenfassung Der Beruf der Gesundheits- und Krankenpflege, deren gesellschaftlicher Status und die Arbeitsbedingungen sind – nicht zuletzt während der Covid-19-Pandemie – vermehrt in den Fokus der Öffentlichkeit gerückt. Der Fachkräftemangel ist allgegenwärtig geworden. Die Wahrnehmung des Pflegeberufs ist von unterschiedlichen, teils gegenläufi...

Zusammenfassung Deutschland verfügt im internationalen Vergleich über eine hohe Anzahl an Ärztinnen/Ärzten und Pflegefachpersonen, wie man Berichten und Ergebnissen aus Datenbanken der EU, der OECD und der WHO entnehmen kann. Werden die Zahlen auf Krankenhausebene betrachtet, bewegt sich Deutschland im Mittelfeld. Unter Hinzunahme von stationären F...

Background The complex, multidimensional nature of healthcare quality makes provider and treatment decisions based on quality difficult. Patient-reported outcome (PRO) measures can enhance patient centricity and involvement. The proliferation of PRO measures, however, requires a simplification to improve comprehensibility. Composite measures can si...

Objective: In German hospital emergency departments (EDs), no definite reimbursement rules exist for patients who die within 24 hours after arrival. Our study aimed to assess whether these cases were recorded and billed as inpatient stays. Furthermore, characteristics of patients who die within 24 hours following arrival at the ED were investigated...

Biosimilars gelten als ein vielversprechender Ansatz, um leistbaren und nachhaltigen Zugang zu biologischen Arzneimitteln zu ermöglichen. Um den Einsatz von preisgünstigeren Biosimilars zu fördern, wenden europäische Länder unterschiedliche Marktsteuerungsmechanismen an, die zum einen am Angebot (Preise) und zum anderen an der Nachfrage nach Biosim...

Background Analyses of out-of-pocket healthcare spending often suffer from an inability to distinguish necessary from optional spending in the data without making further assumptions. We propose a two-dimensional rating of the spending categories often available in household budget survey data where we consider the requirement to pay for necessary...

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026 Global Burden of Disease 2021 Health Financing Collaborator Network † Show footnotesOpen AccessPublished:January 24, 2023DOI:https://doi.org/10.1016/S2214-109X(23)00007-4 Summary Background The COVID-19 pandemic h...

Purpose: Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (...

Objective To investigate whether differences in early death recording in administrative hospital data affect the comparison of acute myocardial infarction (AMI) in-hospital mortality between Germany and the United States (U.S.), and to explore approaches to account for this issue. Design Observational cross-sectional study based on administrative...

Background: Lower global disability and higher quality of life among ischaemic stroke patients was found to be associated with the dispatch of mobile stroke units (MSUs) among patients eligible for recanalizing treatments in the Berlin_Prehospital Or Usual Delivery of stroke care (B_PROUD) study. The current study assessed the cost-utility and cos...

Zusammenfassung In seinem jetzigen Zustand wird das deutsche Gesundheitssystem nicht in der Lage sein, eine ansteigende Zahl alter Menschen in der Bevölkerung mit einer verminderten Zahl qualifizierter Erwerbspersonen zu versorgen. Diese Problematik betrifft besonders die postakute Versorgung von Schwerkranken, wie in einem ersten von zwei Beitrags...

Introduction This study aims to (i) describe the (evidence-based) reimbursement process of hospital individual services, (ii) evaluate the accordance between evidence-based recommendations and reimbursement decision of individual services and (iii) elaborate potential aspects that play a role in the decision-making process in Austria. Methods The...

Zusammenfassung In den nächsten zwei Jahrzehnten werden in Deutschland die Babyboomer aus dem Erwerbsleben ausscheiden. Erwerbsarbeit muss dann von der zahlenschwachen „Pillenknick“-Generation geleistet werden. Mehr ältere Personen in der Gesellschaft bedeuten trotz und teilweise wegen verbesserter medizinischer Möglichkeiten eine höhere Belastung...

Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower e...

Background In 2013–2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources. Methods We examined admi...

Background Health System Performance Assessment (HSPA) is used as a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a systematic HSPA was piloted for Germany. The conceptual framework includes different dimensions, e.g., access, population health, efficiency, and quality...

Background Providing equal access to health care is a major goal of health systems and a criterion for health system performance assessment (HSPA). The first systematic HSPA for Germany has been piloted in 2021. Access is one dimension of the conceptual framework (others are, e.g., population health, quality, and efficiency), which will be analysed...

Background Improving the population health, both its level and equity, is a major goal of health systems. Health System Performance Assessment (HSPA) is a tool to evaluate the performance of different health system dimensions, e.g., population health, access, efficiency. For the first time, a systematic HSPA was piloted for Germany including the di...

Background Improved efficiency is one overall goal in WHO’s Health Systems Framework. Efficiency is an important dimension of health system performance assessment (HSPA). HSPA is used as a tool to monitor and evaluate the performance of health systems and to support evidence-based policymaking. In the pilot study for a first German HSPA, efficiency...

Background Health System Performance Assessment (HSPA) is a tool for the evaluation of the performance and efficiency of a health system and can be used for evidence-based policymaking. For the first time, a country specific HSPA for the German health system is piloted with a focus on trend and equity analyses. Methods Based on the conceptual fram...

Assessing the performance of health systems is essential to initiate policy processes that further strengthen health systems to improve population health. Starting with WHO's World Health Report of 2000, Health System Performance Assessments (HSPA) gained increasing attention in research and policy. By now, several comparative HSPA initiatives of i...

Background Health System Performance Assessment (HSPA) is a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a country specific HSPA is currently being piloted for Germany. Methods The HSPA is based on a newly developed conceptual framework including nine dimensions (e.g....

Background Hospitals and their health care staff were severely impacted by the Covid-19 pandemic. Many health professionals faced high levels of stress and burn-out due to unfavorable work environments, limited staffing and highly pressured workloads. Yet, even prior to the pandemic, health professionals in many countries faced challenging work env...

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age gr...

Background: Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow thi...

Hintergrund und Stand (inter)nationaler Forschung: Empirische Ansätze zur Bevölkerungssegmentierung gewinnen international zunehmend an Bedeutung, besonders bei der Entwicklung effektiver, patientenzentrierter Versorgungskonzepte für eine regional definierte Bevölkerung. Auch in Deutschland besteht seit längerem die politische Forderung nach einer...

Objectives: Evidence-based decision-making is the sine qua non for safe and effective patient care and the long-term functioning of health systems. Since 2020 Digital Health Applications (DiHA) in Germany have been undergoing a systematic pathway to be reimbursed by statutory health insurance (SHI) which is attracting attention in other European co...

Zusammenfassung Erhalten Patient*innen Gesundheitsleistungen, die nicht indiziert sind, kann dies mit Fehldiagnosen und überflüssigen Folgeuntersuchungen einhergehen und sowohl die Patient*innen als auch das Gesundheitssystem unnötig belasten. Das Monitoring nicht indizierter Versorgung bzw. der Indikationsqualität kann Handlungsbedarfe identifizie...

Zusammenfassung Die Studie untersuchte die Wechselbereitschaft von gesetzlich Versicherten unter Berücksichtigung von Subgruppenunterschieden und Beweggründen. Wechselbereit waren 23% der Befragten. Die Kostenerstattung von Leistungen, Serviceleistungen und die Höhe des Zusatzbeitrags waren die meistgenannten Gründe für einen Wechsel. Subgruppenunt...

Introduction: The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain insights into the perspective of people with private health insurance (PHI) in Germany along the p...

Introduction The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the wel...

Background Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and qu...

Der Sammelband basiert auf einer gleichnamigen digitalen Ringvorlesung, die im Wintersemester 2020/2021 und Sommersemester 2021 an der Christian-Albrechts-Universität zu Kiel stattfand. In 16 Beiträgen und drei Vortragszusammenfassungen äußern sich anerkannte Expertinnen und Experten zu verschiedenen Fragen und Themenfeldern rund um die Coronavirus...

Background The COVID-19 pandemic has developed into an unprecedented global challenge. Differences between countries in testing strategies, hospitalisation protocols as well as ensuring and managing ICU capacities can illustrate initial responses to a major health system shock, and steer future preparedness activities. Methods Publicly available d...

Background Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous resear...

Background: Routine data have shown a stark increase in home mechanical ventilation (HMV) in Germany in recent years. However, the development of HMV in the first year of the COVID-19 pandemic is unknown. Methods: Case numbers of initiations, control examinations, and terminations of invasive and non-invasive HMV in 2017 – 2020 were analysed. ICD-1...

Objectives This study aimed to develop a framework facilitating (1) the maturity assessment of healthcare systems regarding patient-reported outcome measure (PROM) implementation and (2) the comparison of different healthcare systems’ PROM implementation levels to guide discussions and derive lessons for regional, state-level, and national PROM ini...

What are skill-mix innovations and why are they relevant? This systemic analysis of health workforce skill-mix innovations provides an overview of the evidence and lessons for implementation across multiple countries. The authors focus on six core segments of health systems: health promotion and prevention, acute care, chronic care, long-term and p...

Objectives Evidence-based decision-making is the sine qua non for safe and effective patient care and the long-term functioning of health systems. Since Digital Health Applications (DiHA) in Germany have been undergoing a systematic pathway to be reimbursed by statutory health insurance for more than one and a half years, the procedure is also attr...

In Germany, some digital health applications (DiHA) became reimbursable through the statutory health insurance system with the adoption of the Digital Healthcare Act in 2019. Approaches and concepts for the German care context were developed in an iterative process, based on existing concepts from international experience. A DiHA categorization was...

Background Frailty is accompanied with a reduced physical capacity, mobility, muscle strength and endurance. (Pre-)Frailty is present in an older surgical population in up to 50% with an increased risk for peri- and post-surgical complications. Consequently, these patients often suffer from a delayed or diminished recovery, loss of autonomy and qua...

In this European public health news, we are touching upon urgent public health issues where European and even global collaboration is essential. De Kat et al. present the European Immunization agenda 2030, endorsed by all 53 countries in the European Region. This agenda intends to keep immunization as a priority on the political agenda and—as vacci...

Zusammenfassung Die Covid-19-Pandemie stellt seit Anfang 2020 insbesondere die Gesundheitssysteme weltweit vor ungeahnte Herausforderungen und führte u. a. dazu, dass ursprüngliche Intensivkapazitäten in einigen Ländern nicht zur Behandlung aller Patienten ausreichten. In diesem Beitrag werden die Entwicklungen der Covid-19-Hospitalisierungen und d...

Die dänische Krankenhausreform wird seit Jahren immer wieder als Vorbild für Deutschland diskutiert. Das Innovationsfondsprojekt „Krankenhaus: Impulse für Deutschland aus Dänemark (K:IDD)“ hat die Übertragbarkeit des dänischen Modells auf die hiesige Versorgung untersucht. Im Forschungskonsortium bestand Einigkeit, dass die weiteichende integriert...

Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. Design Systematic analysis. Setting Participants were aged ≥70 from 204 countries and terri...

Objectives To (1) describe the (evidence-based) reimbursement process of hospital individual services, (2) evaluate the accordance between evidence-based recommendations and reimbursement decision of individual services and (3) elaborate potential aspects that play a role in the decision-making process in Austria. Method The reimbursement process...