Volker Amelung

• Hannover Medical School

Ölreichtum, eingeschränkte Menschenrechte in einer absoluten Monarchie. Saudi-Arabien hat einen rasanten und tiefgreifenden Modernisierungsprozess begonnen und will mit der Vision 2030 die Gesellschaft modernisieren, wobei das Gesundheitswesen eine tragende Säule bildet. Armin Scheuer, Ex-VP und Executive Director EMEA bei HIMSS, erläutert diese St...

Male-specific diseases are health problems that either occur exclusively in men or occur more frequently and/or more severely in men. Some examples are erectile dysfunction (erectile dysfunction), benign prostatic hyperplasia (non-cancerous enlargement of the prostate that can lead to problems urinating), prostate cancer and testicular cancer. The...

Background: The health care situation of men, especially men in younger phases of life, before typical prostate problems occur, has been little studied. The aim of the study was to determine the status quo of care in the field of men's health in Germany, and to identify obstacles and potential for optimization in the implementation of preventive an...

Background The digitalization of healthcare systems is expected to lead to improvements in the quality and efficiency of healthcare services. Despite Germany’s leading economic and technological position, the implementation and utilization of digital health solutions is lagging far behind internationally. A look at other countries shows that the di...

Background For myocardial infarction, in-hospital lethality is still significantly higher in women than in men in Germany. Medical guidelines and nursing expert standards include recommendations for gender-sensitive care (GSC+), but it is unknown how these are implemented in health care practice. Research question: Which measures facilitate the imp...

Purpose Non-specific low back pain (NLBP) exerts a profound impact on global health and economics. In the era of Web 3.0, digital therapeutics offer the potential to improve NLBP management. The Rise-uP trial introduces a digitally anchored, general practitioner (GP)-focused back pain management approach with the Kaia back pain app as the key inter...

Zusammenfassung Hintergrund Für Jugendliche, die als „digital natives“ gelten und an Typ-1-Diabetes (T1D) leiden, bieten digitale Interventionen die Möglichkeit, Gesundheitskompetenz zu stärken. Die COVID-19-Pandemie („coronavirus disease 2019“) hat die Implementierung digitaler Interventionen beschleunigt. Jedoch bleibt die Frage offen, ob sie um...

Introduction Adolescents with type 1 diabetes mellitus (T1D) require a high level of health literacy (HL) to prevent complications. It remains unclear what potential digital interventions have for promoting HL among adolescents with T1D, as viewed by physicians working with this target group. Additionally, it is unclear how the institutions (inpati...

Introduction Digital health intervention offers the potential to enhance health literacy, which is crucial for effective diabetes management, especially among adolescents. Diabetes is a major global public health issue, leading to devastating complications and increasing mortality rates. The incidence of type 1 diabetes mellitus (T1DM) is also on t...

Introduction The German Innovation Fund supports projects that aim to improve healthcare through integration and intersectoral collaboration. As is typical for collaborative innovation projects, partners often pursue different objectives, which can create tensions and affect outcomes. The study aims to explore the causes and effects of tensions in...

Introduction: Patients with Parkinson's Disease (PD) require an all-encompassing and individualized care including pharmacological as well as non-pharmacological treatment approaches, such as physical therapy, occupational therapy and speech and swallowing therapy. ParkinsonAKTIV is an innovative, multidisciplinary, and comprehensive approach to g...

In the transition from fragmented to integrated care, tensions are inevitable. Contradictions between the actors of the different professions involved can have negative but also positive effects on change processes in the healthcare system. This is especially true for integrated care, where collaboration among the workforce is pivotal. Therefore, e...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovationsfonds des Gemeinsamen Bundesausschusses. Introduction Exercise interventions are well established in the treatment of chronic ischaemic heart disease (CIHD) and type 2 diabetes mellitus (T2DM). Yet, there remains a significa...

Background Evidence shows that living with diabetes mellitus type 1 (T1DM) in adolescent age is particularly challenging and difficult to manage. A high level of health literacy is important to prevent and avoid debilitating complications. Despite the increasing prevalence and incidence of T1DM by adolescent and the large use of digital health inte...

Die Patientenorientierung scheint – zumindest an der Oberfläche – alle Akteure des Gesundheitswesens zu einen. Unter der Oberfläche existiert aber eine Vielzahl von berechtigten Partikularinteressen. In der allgemeinen Managementlehre gibt es eine umfassende Diskussion zu den Implikationen unterschiedlicher Interessen und vor allem dazu, wann sie k...

Objective: To evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus active physical interventions on pain intensity and disability in adults with nonspecific chronic low back pain. Introduction: Research has shown that primary care biopsychosocial interventions (PCBI) can reduce pain intensity and disability. Wh...

Background Until now, scholarship on innovation processes in healthcare systems lack an in-depth appreciation of tensions. Tensions often revolve around barriers and result from individual assessments and prioritizations that guide actions to eventually overcome these barriers. In order to develop a more differentiated understanding of tensions’ ro...

Treatment of chronic lower back pain (CLBP) should be stratified for best medical and economic outcome. To improve the targeting of potential participants for exclusive therapy offers from payers, Freytag et al. developed a tool to classify back pain chronicity classes (CC) based on claim data. The aim of this study was to evaluate the criterion va...

Background: Nonspecific chronic low back pain (CLBP) is a complex symptom with numerous possible causes and influencing factors. Understanding how modifiable factors affect the course of CLBP is important for preventing progression. As the COVID-19 pandemic has changed the lifestyle of many people, this study paper assessed whether it also changed...

Background Best outpatient treatment of nonspecific chronic low back pain is high-dosed exercise that is maintained after therapy. Primary care biopsychosocial intervention (PCBI) is an outpatient multicomponent intervention that includes an active component (exercise, physical activity, or physiotherapy) and at least one psychological, social, or...

Background Lifestyle interventions are a cornerstone in the treatment of chronic ischaemic heart disease (CIHD) and type 2 diabetes mellitus (T2DM). This study aimed at identifying differences in clinical characteristics between categories of the common lifestyle intervention targets BMI, exercise capacity (peak V̇O 2 ) and health literacy (HL). M...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Federal Joint Committee Germany Background Ischaemic heart disease is the leading cause of global mortality and when accompanied by type 2 diabetes mellitus (T2DM), prognosis is even worse. Lifestyle (LS) interventions are recommended,...

Häufig werden Versicherungen als Ursprung von MCOs betrachtet. Auch wenn dies für die Wiederbelebung von Managed Care seit Mitte der 70er Jahre durchaus zutrifft, liegen die Ursprünge in den USA eher bei der Risikoübernahme durch die Leistungsersteller in den 20er Jahren in Form der sogenannten Prepaid Group-PraticesPrepaid Group Practices (PGP) (P...

„After a turbulent decade of trial and error, that experiment can be characterized as an economic success but a political failure“, konstatiert Robinson (2001, S. 2622) für die USA vor einigen Jahren treffend. Insbesondere stellt sich die Frage, ob MCOs Managed Care oder Managed Costs betrieben haben. Kritiker heben hervor, dass letzteres häufiger...

Unter Managed-Care-Organisationen (MCOs) werden Institutionen verstanden, die ausgewählte Managed-Care-Instrumente einsetzen und zumindest bis zu einem gewissen Grad die Funktionen Versicherung und Leistungserstellung integrieren. Neben diesen MCOs existieren Institutionen, die im Managed-Care-Umfeld agieren.

Eine der wichtigsten Voraussetzungen für qualitativ hochwertige und wirtschaftliche Behandlungsergebnisse ist die Auswahl geeigneter Leistungserbringer, mit denen eine MCO Versorgungsverträge abschließt (selektives KontrahierenKontrahieren, selektives).

Managed Care ermöglichte die Durchsetzung einer Vielzahl von Organisationsformen, die von den Anbietern von Gesundheitsdienstleistungen eingeführt wurden. Einerseits gibt es die traditionellen Modelle wie die Independent Practice Associations (IPAs), welche die Interessen der Ärzte in Verkaufsgenossenschaften vertreten. Diese existieren neben ander...

Unter einer Evaluation versteht man in den Gesundheitswissenschaften eine umfassende Messung und Bewertung der Nutzen und Kosten von Gesundheitstechnologien. Der Begriff „Gesundheitstechnologien“ ist hier sehr weit gefasst und beinhaltet folgende Prozesse und Produkte.

Unter dem Konzept des Gatekeepingsgatekeeping wird verstanden, dass jede Behandlungsepisode mit Ausnahme von Notfällen und einigen vorab definierten Leistungsbereichen mit einem Besuch bei einem individuell bestimmten Allgemeinarzt beginnt. Entsprechend wird auch von Hausarztmodellen gesprochen. Der Versicherte delegiert die Entscheidung, ob die be...

Managed Care führt zu einer deutlichen Steigerung der Anzahl unterschiedlicher institutioneller Arrangements. Aus der ehemaligen „Cottage-Industry“ im Gesundheitswesen wird zunehmend eine ausdifferenzierte Dienstleistungsbranche mit den unterschiedlichsten Anbietern.

Die Versicherten bzw. Patienten stehen einer Versorgung durch Managed Care tendenziell skeptisch gegenüber. Managed Care verlangt von den Versicherten/Patienten eine Einschränkung der Wahlfreiheit des Arztes und der möglichen Behandlungen und die Übernahme einer größeren Verantwortung für die eigene Gesundheit, was von ihnen vielleicht gar nicht ge...

Die Gestaltung von Vergütungssystemen für die Leistungserbringer ist ein wesentliches Steuerungsinstrument von Managed Care. Zum besseren Verständnis dieses Instruments und seiner Wirkungsweise werden zunächst die Grundlagen von Vergütungssystemen ganz allgemein dargestellt um dann genauer auf die Vergütungssysteme in Managed Care einzugehen.

Seit die „Wall Street das Gesundheitswesen entdeckt hat“, ist nicht nur die Zeit der friedlichen Koexistenz zwischen Leistungserbringern und -finanzierern vorbei, sondern es hat sich ein völlig neuer BeratungsmarktBeratungsmarkt entwickelt.

Der Einfluss von Managed Care auf die Kosten der Versorgung ist nicht einfach zu messen. Nur wenige Untersuchungen vergleichen die gesamten Kosten der MCOs mit denen der traditionellen Fee-for-Service Versicherung. Untersucht werden häufig nur Teilaspekte, da ansonsten die Komplexität nicht mehr zu bewältigen wäre. So werden die Ausgaben für Kranke...

Der folgende Abschnitt wendet sich vor allem an theorieinteressierte Leser. Anhand der beiden aus der Neuen InstitutionenökonomieNeue Institutionenökonomie stammenden Ansätze sollen einige Grundgedanken zur Gestaltung von Institutionen und von Anreiz- und Kontrollsystemen vorgestellt werden.

Eine wesentliche Kritik an Managed Care beruht auf dem Argument, dass die gesundheitliche Versorgung bestimmter Bevölkerungsgruppen verschlechtert wird. Auch diese Frage ist von Robinson und Steiner (1998) in ihrer Auswertung empirischer Untersuchungen zu beantworten versucht worden. Untersucht wurde dabei die Versorgung von Kindern, von Frauen mit...

Im Rahmen dieser Einleitung soll zuerst auf die Managed Care fördernden und hemmenden Entwicklungstendenzen eingegangen werden. Anschließend wird ein definitorisches Gerüst entwickelt, um dann konkret auf die Instrumente und Organisationsformen und die daraus resultierenden Konsequenzen einzugehen.

Im Folgenden sollen die wesentlichen Grundzüge des hoch komplexen amerikanischen GesundheitswesensGesundheitswesen, amerikanische aufgezeigt werden.

Es überrascht nicht, dass Managed Care bei den Ärzten und den Versicherten/Patienten auf Kritik stößt. Das traditionelle System überzeugt eben vor allem durch die Großzügigkeit der zur Verfügung stehenden Mittel und die gewährte Wahlfreiheit und Entscheidungsautonomie. Die Befürchtungen der Ärzte und Patienten bezüglich der Qualitätsverschlechterun...

Managed Care mit schlechter Qualität in Verbindung zu bringen gehört teilweise zum guten Ton. Insbesondere wird die Frage aufgeworfen, wie MCOs möglicherweise in Extremsituationen agieren, wenn ein Patient schwerstkrank ist. Weniger wird betrachtet, wie sie sich über die große Menge von normalen Fällen verhalten. Dies dokumentiert nochmals das erhe...

Goal of the study: An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountab...

Background Alcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with...

Obwohl psychische Erkrankungen weit verbreitet sind und stetig an Bedeutung zunehmen, führen verschiedene Hindernisse dazu, dass psychisch Erkrankte häufig nicht die notwendige Hilfe in Anspruch nehmen. Gründe hierfür können Vorurteile, Stigmatisierung und Diskriminierung sein, mit denen sich Menschen mit psychischen Erkrankungen trotz Aufklärungsm...

Background Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended for chronic lower back pain (CLBP) treatment, but its economic benefit remains to be clearly demonstrated. The purpose of this study is to analyse the effect of a 12-month MBR programme of behavioural change coaching and device-supported exercise on direct medic...

Background: Treatment of chronic lower back pain (CLBP) should be stratified for best medical and economic outcome. To improve targeting of potential participants for exclusive therapy offers by payers, Freytag et al. developed an algorithm to identify back pain chronicity classes (CC) based on claims data. The aim of this study was the external va...

Introduction: Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended to treat chronic lower back pain (CLBP). However, its economic benefit remains to be clearly demonstrated. Objective: To analyse the effect of a 12-month MBR with behaviour-change coaching and device-supported exercise on direct medical costs, sick leave and...

Background The extend of lung disease remains the most important prognostic factor for survival in patients with cystic fibrosis (CF), and lack of adherence is the main reason for treatment failure. Early detection of deterioration in lung function and optimising adherence are therefore crucial in CF care. We implement a randomized controlled trial...

Background The health care situation of geriatric patients is often multifaceted, complex and often overlaps with social living conditions. Due to the lack of cross-sectoral and interprofessional health care geriatric patients often, receive insufficient care. Only a holistic view enables a comprehensive evaluation of the complex health risks, but...

Introduction Guidelines recommend lifestyle intervention in chronic ischaemic heart disease (CIHD) and type 2 diabetes mellitus (T2DM). However, evidence from randomised controlled trials is scarce in patients with combined entities. Methods and analysis The Lifestyle Intervention in Chronic Ischaemic Heart Disease and Type 2 Diabetes (LeIKD) tria...

Die Digitalisierung im Gesundheitswesen wurde durch Gesundheitsminister Spahn deutlich forciert. Auch die Corona-Pandemie hat die Akteure motiviert, digitale Lösungen stärker in Betracht zu ziehen. Technologien allein können die Versorgung jedoch nicht verbessern. Entscheidend ist, dass sie durch die verschiedenen Akteure auch genutzt werden. Dafür...

As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson's disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborativ...

Background On 31 December 2016, a total of 1206 physicians participated in the outpatient care of chronic pain patients according to the criteria of a special pain management program (QSV). Because of the largely existing shortage of treatment resources for chronic pain patients, there is a lack of data regarding the evaluation of outpatient pain m...

Seit über 20 Jahren setzt sich der Bundesverband Managed Care e. V. (BMC) für die Weiterentwicklung eines zukunftsfähigen und patientenorientierten Gesundheitssystems ein. Im Fokus steht nicht die eine, vermeintlich optimale Versorgung oder Steuerung, sondern das ständige Streben nach besseren, alternativen Lösungen. Dabei zielt der BMC darauf ab,...

Purpose Non-specific low back pain (NLBP) causes an enormous burden to patients and tremendous costs for health care systems worldwide. Frequently, treatments are not oriented to existing guidelines. In the future, digital elements may be promising tools to support guideline-oriented treatment in a broader range of patients. The cluster-randomized...

So begrüssenswert interprofessionelle Zusammenarbeit ist, so schwierig erweist sich ihre Umsetzung. Eine essentielle Rolle für Gegenwart wie Zukunft spielen dabei die vier Kulturen und der "Normalfall" des Gesundheitssystems. Eine Bestandsaufnahme und Empfehlungen.

Background Organ donation-rates using deceased donors and organizational approaches to organ donation differ drastically between countries at a similar level of health care as measured by the Euro Health Consumer Index (EHCI). Material/Methods Expert opinions from intensive care nurses, physicians, transplant coordinators and transplant surgeons f...

Welche Aspekte führen dazu, dass ein Gesundheitssystem eine besonders gute Qualität erreicht, mit niedrigen Beitragssätzen der Versicherten auskommt oder gut durch eine Krise wie die Covid-19-Pandemie steuert? Der Beitrag versteht sich als Opinion Paper am Beispiel Dänemark und dessen Krankenhausreform, mit Überlegungen unter welchen Gegebenheiten...

Welche Modelle und Ansätze sind für Deutschland erfolgversprechend? Die BMC-Studienreise in die Schweiz gab vielerlei Impulse für Veränderung - insbesondere in den Bereichen Versorgungskoordination, alternative Vergütungsmodelle und Telemedizin - die in diesem Beitrag dargestellt werden.

In the following section the main features of the highly complex American healthcare system will be exhibited. The section will focus on the multiple payers for healthcare services existing in the United States and borrow heavily from various authors (see Niles 2011; Sultz and Young 2010; Davidson 2010; Greenwald 2010; Shi and Singh 2013; Jonas et...

The Blue Cross and the Blue Shield health plans were the first health insurance plans in the United States. Together with these insurances, the first health maintenance organisations (HMOs) were also formed in the midst of the Great Depression. Some of the pioneering HMOs include the Kaiser Foundation Health Plans (1937), the Group Health Associati...

The design of compensation systems for service providers is an essential control instrument in managed care. In order to better understand this instrument and its effects, the basic principles of compensation systems will first be generally described (see Fig. 10.1) so that the managed care compensation systems can be outlined in more detail.

In healthcare, a variety of different measures and instruments can be applied to manage the quality of healthcare. The following chapter will discuss the usefulness and effectiveness of guidelines and clinical paths, disease management and chronic care, case management, patient coaching and quality management as specific instruments for quality man...

Managed care leads to a considerable increase in the number of different institutional arrangements. The former “cottage industry” of healthcare has transformed into a differentiated service industry with diverse providers. There are several reasons for the development from the simple division of the delivery and purchasing of services to this vari...

The following section is particularly directed at readers who are interested in theory. Using the two main approaches of the new institutional economics (Schauenberg et al. 2005; Coase 1988, 1993; Demsetz 1967, 1968, 1988; North 1991; Jensen and Meckling 1976; Hart and Moore 1990; Furubotn and Pejovich 1974; Alchian and Demsetz 1972; Sloan 1988), c...

It is no surprise that managed care is met with criticism from physicians as well as insured/patients. The traditional system is convincing particularly through its generosity with the available funds and the freedom to choose as well as the decision-making autonomy which it grants. The physicians’ and patients’ fears regarding a deterioration of q...

In this introduction, the development tendencies that aid and impede managed care will first be discussed and subsequently, a definition framework developed. This framework will address in more detail the instruments and organisational forms, as well as the consequences that result. The so-called called “managed care backlash” that first manifested...

An organisation may be referred to as a managed care organisation (MCOs) if, (a) it implements management instruments, (b) integrates the function of insurance, (c) at least partially provides of healthcare services, (d) aids in the development and implementation of managed care instruments, and/or (e) offers consultation services in dealing with m...

Since “Wall Street discovered healthcare” a long time ago, not only is the age of peaceful coexistence between service providers and payers is over, but an entirely new consulting market has developed. However, the types of products differ widely. The products can be broken down into three categories. First, there are consultation products that are...

The influence of managed care on the cost of care is difficult to assess. Only few studies compare the entire cost of MCOs with those of the traditional fee-for-service insurances. Often only certain aspects are investigated, since the complexity would otherwise be impossible to address. Thus, the expenses of hospital services, the use of service p...

Linking managed care with poor quality sometimes goes hand in hand. This particularly raises the question of how MCOs may act in extreme situations when a patient is seriously ill. However, what people pay less attention to is how MCOs act in the large amount of normal cases (Reschovsky et al. 2002). This once again documents the considerable diffi...

A main point of criticism of managed care is based on the argument that it worsens the care of certain population groups. Robinson and Steiner (1998) also attempted to answer this question in their evaluation of empirical studies. Study results analysing the care of children, women with low income and the elderly showed that the treatment of childr...

The insured and patients tend to be sceptical of healthcare through managed care. Managed care limits the patients’/insured’s freedom to choose physicians and possible treatments as well as requiring patients to assume greater responsibility for their own health, which perhaps they do not want. Robinson (2001, p. 2623) aptly remarked: “Consumers ex...

Managed care allowed for the penetration of a variety of organisational forms instituted by providers of healthcare services. On the one hand, there are the traditional models such as Independent Practice Associations (IPAs) that defend the physicians’ interests as well as Preferred Provider Organisations (PPOs) that look after the interests of sal...

In health science evaluation refers to a comprehensive assessment and evaluation of the benefits and costs of healthcare technology. The term “healthcare technology” is very broad and includes the following processes and products:

In healthcare, a variety of different measures and instruments can be applied to manage the cost of healthcare. The following chapter will discuss the usefulness and effectiveness of gatekeeping, formularies and utilization reviews. These three cost management tools are especially relevant to Managed Care. In gatekeeping, most treatment episodes be...

“After a turbulent decade of trial and error, that experiment can be characterized as an economic success but a political failure”, stated Robinson (2001, p. 2622), for the United States some years ago. In particular, the question was raised of whether MCOs used “managed care” or “managed costs”. Critics emphasise that MCOs focused more on managing...

One of the most important preconditions for high-quality and economically effective treatment results is a selection of suitable service providers with whom an MCO concludes supply contracts (selective contracting). The conclusion of selective contracts is so significant for managed care and healthcare management that it is considered crucial to th...

Objective: The purpose of this study was to find applicable clusters for the development of different treatment pathways in an inpatient multimodal pain-therapy setting based on the multifaceted nature of CLBP. Methods: Based on data of questionnaires (Hospital Anxiety and Depression Scale (HADS), Marburg Questionnaire on Habitual Health Findings (...

Zusammenfassung Hintergrund Lebensstilveränderungen können das Risiko, an Diabetes mellitus Typ 2 zu erkranken, senken. Das evaluierte aha!2.0-Programm („ab heute anders!“) fokussiert einerseits auf die Erkennung des Diabetes-mellitus-Typ-2-Risikos und anderseits auf die Modifizierung des Lebensstils zur Reduktion bekannter Risikofaktoren. Ziel von...