Reinhard Busse

Technische Universität Berlin | TUB · Department of Health Care Management

Despite intensified efforts to address waste and inefficiencies in healthcare in the last decade, the ability of health systems in Europe to identify and reduce low-value care varies. Through the EU Expert Group on Health System Performance Assessment’s work, a new comprehensive definition was proposed and a framework to distinguish different types...

Background While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and...

Objectives: Patient-reported outcome measures (PROMs) have emerged as a promising approach to involve patients in their treatment process. Beyond serving as outcome measures, PROMs can be applied to provide feedback to healthcare providers and patients, thereby offering valuable insights that can improve health outcomes and care processes. This ove...

Background Acute abdominal pain (AAP) is a major driver for capacity-use in emergency departments (EDs) worldwide. Yet, the health care utilization of patients with AAP before and after the ED remains unclear. The primary objective of this study was to describe adult patients presenting to the ED with AAP and their outpatient care (OC) use before a...

Hintergrund: Die Versorgung in Deutschland ist nicht immer bedarfsgerecht und weist ein erhebliches Optimierungspotenzial auf. Die Innere Medizin (IM) spielt aufgrund ihrer langen Tradition eine besondere Rolle im deutschen Gesundheitssystem. Daher scheint ein Blick auf das Steuerungspotenzial der IM besonders relevant, d. h., welche Patienten woan...

Background Despite comparatively low rates of COVID-19 admissions and recorded deaths in sub-Saharan Africa (SSA), the pandemic still had significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence of HSU in SSA during the pandemic, focusing on types of studies, changes in HSU compa...

Background Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients’ perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (P...

Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with a focus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest. This paper aims to illustrate how V...

Background Health System Performance Assessments (HSPA) and analyses of unwarranted regional variation in health care both aim at identifying strengths and weaknesses of health systems to improve care. Applying HSPA’s conceptual approach of interrelated health system dimensions (e.g., access, quality) to regional levels might help to better underst...

Patient Reported Outcome Measures (PROMs) have emerged as a promising approach to involve patients in their treatment process. Beyond serving as outcome measures, PROMs can be applied to provide feedback to health care providers and patients, thereby offering valuable insights that can improve health outcomes and care processes. This overview offer...

Background Even more than hospital care in general, intensive care and mechanical ventilation capacities and its utilization in terms of rates, indications, ventilation types and outcomes vary largely among countries. We analyzed complete and nationwide data for Germany, a country with a large intensive care sector, before, during and after the COV...

Background Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensiv...

Summary Background Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injur...

Aim In Germany, a long-lasting debate about the need for a hospital reform, including centralisation, now resulted in reform plans. As cutbacks to essential services such as hospitals are an emotional topic, the public should be properly informed, which is a central role of the media. Based on a media analysis of a large-scale hospital reform in De...

Background In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death cases in hospital inpatient data. This study exami...

Zusammenfassung Entlang des Versorgungspfads gibt der Beitrag zunächst einen Überblick über den Reformbedarf in der Notfallversorgung und dem Rettungswesen. Darauf aufbauend werden internationale Entwicklungen und Studienergebnisse skizziert und aufgezeigt, welche Lösungen in anderen Ländern zum Einsatz kommen, um diesen Problemen zu begegnen. Ansc...

Zusammenfassung Die Regierungskommission für eine moderne und bedarfsgerechte Krankenhausversorgung hatte einen Reformvorschlag vorgelegt, das aus den drei Kernelementen (1) Einteilung der Krankenhäuser in bundeseinheitliche Versorgungsstufen (Level), (2) Gliederung der Krankenhausleistungen in Leistungsgruppen mit definierten Qualitätsanforderunge...

Introduction Most countries worldwide cover oral health (OH) only partially within public systems compared to other health services. As a result, OH care can incur financial hardship for those in need and is the second main driver of catastrophic health spending in Europe. Efforts to improve OH coverage and integration into public health systems ha...

Background Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-base...

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important follow...

Background: Due to the increasing shortage of specialists, disproportionately rising costs and inadequate quality of care, Germany is planning a fundamental hospital reform. The government commission has developed the central principles for this reform. The aim is to achieve a centralization of hospital services in oversupplied metropolitan areas b...

Beschreibung: Angesichts des wachsenden Fachkräftemangels im Gesundheitssektor und der steigenden Gesundheitsausgaben wird die Vermeidung von Überversorgung immer wichtiger. Auch aus Patientensicht ist es essentiell, sicherzustellen, dass die erbrachten Gesundheitsleistungen einen (nachgewiesenen) Nutzen bieten. Doch in welchem Ausmaß tritt Überver...

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of D...

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...

Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health...

Background Hip arthroplasty (HA) and knee arthroplasty (KA) are high-volume procedures. However, there is a debate about the quality of indication; that is, whether surgery is truly indicated in all patients. Patient-reported outcome measures (PROMs) may be used to determine preoperative thresholds to differentiate patients who will likely benefit...

Background Anorectal malformations (ARMs) are complex congenital anomalies. The corrective operation is demanding and schedulable. Based on complete national data, patterns of care have not been analyzed in Germany yet. Methods All cases with ARM were analyzed (1) at the time of birth and (2) during the hospital stay for the corrective operation, b...

BACKGROUND Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients’ perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (P...

Link to the article: https://link.springer.com/article/10.1007/s00142-023-00650-x Ambulatory surgery or day surgery (admission, surgery and discharge on the same day) has become increasingly more important internationally. Nevertheless, there are large differences in the proportion of day surgery interventions between countries. Investigation of...

The importance of day surgery as a less costly alternative compared to conventional inpatient hospital stays is growing internationally. The rate of day surgery activities has increased across Europe. However, this trend has been heterogeneous across countries, and might still be below its potential. Since payment systems affect how providers offer...

Introduction The Coronavirus Disease 2019(COVID-19) pandemic has undoubtedly exposed weaknesses in health systems, especially in sub-Saharan Africa (SSA). Despite comparatively low rates of COVID-19 admissions and recorded deaths in SSA, the pandemic still had a significant impact on health service utilization (HSU). The aim of this scoping review...

Background Retrospective hospital quality indicators can only be useful if they are trustworthy signals of current or future quality. Despite extensive longitudinal quality indicator data and many hospital quality public reporting initiatives, research on quality indicator stability over time is scarce and skepticism about their usefulness widespre...

Monetary and non-monetary incentives for the utilization of Patient-reported outcomes

Background Reducing health inequities is an important goal of high-performing health systems. Therefore, health inequities need to be assessed systematically, continuously and for all relevant aspects of a health system. The tool “health system performance assessments” (HSPA) aims at monitoring and evaluation the achievement of predefined goals and...

Background The COVID-19 pandemic has affected health systems and impacted health service utilization (HSU) globally. The aim of this scoping review is to synthesize the available evidence on HSU in sub-Saharan Africa during the COVID-19 pandemic focusing on (1) changes in HSU compared to the pre-pandemic period, (2) changes in HSU amongst particula...

Background HSPA is a tool to monitor, evaluate, and improve health systems based on their achievements within different dimensions, e.g., access to care, quality, and population health. Next to the overall system, HSPA also allows to analyze its performance for specific groups across dimensions. In a pilot for a German HSPA, a conceptual framework...

Background Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between healthcare providers persists, while current quality indicators rarely capture the patients’ perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PR...

Background The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the ty...

Hintergrund und Stand der Forschung: Medizinische Leistungen, die keinen Nutzen für den Patienten aufweisen bzw. deren Potenzial für Schaden größer ist als der potenzielle Nutzen, gelten als unangemessen und nicht indiziert. Die Analyse der Prävalenz und Trends unangemessener Versorgung kann Handlungsbedarfe aufdecken, um die Effizienz des Gesundhe...

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...

Purpose To elaborate a concept for implementing digital health applications (DiHA), including prioritisation criteria (PC) for the Austrian context and an overview of available prioritised DiHAs. Methods Based on European DiHA-listings and input by Austrian experts, a categorised meta-directory of DiHAs was created. PC were developed to reflect, i...

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...