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... That is why researchers asked for renewed consent to link data during the second wave of the lidA survey if a respondent indicated during the interview that s/he changed health insurers . What makes the process even more difficult is the fact that the electronic health card with an insurer-independent new personal life-long (unique) insurance number was introduced on 1 January 2011 with a transition period until 31 December 2014 . ...
Research based on health insurance data has a long tradition in Germany. By contrast, data linkage of survey data with such claims data is a relatively new field of research with high potential. Data linkage opens up new opportunities for analyses in the field of health services research and public health. Germany has comprehensive rules and regulations of data protection that have to be followed. Therefore, a written informed consent is needed for individual data linkage. Additionally, the health system is characterized by heterogeneity of health insurance. The lidA-living at work-study is a cohort study on work, age and health, which linked survey data with claims data of a large number of statutory health insurance data. All health insurance funds were contacted, of whom a written consent was given. This paper will give an overview of individual data linkage of survey data with German claims data on the example of the lidA-study results. The challenges and limitations of data linkage will be presented. Despite heterogeneity, such kind of studies is possible with a negligibly small influence of bias. The experience we gain in lidA will be shown and provide important insights for other studies focusing on data linkage.
Die Einführung einer elektronischen Patientenakte in Deutschland verzögert sich seit Jahren. Im Vergleich zur Bundesrepublik sind hier international strukturähnliche Länder – insbesondere diejenigen mit skandinavischer Prägung wie Dänemark und Estland – bei der Etablierung von elektronischen Patientenakte sehr viel weiter (7 Kapitel 9 in diesem Band). Diesen Vorsprung erreichten diese Länder mittels starker Governance und durch frühzeitige Setzung verbindlicher Ziele und zeitlicher Rahmen bei der Digitalisierung des Gesundheitswesens. Inhalte und Funktionen der elektronischen Patientenakte wurden von Anfang an klar definiert und technische sowie Interoperabilitätsstandards vorgegeben. Deutschland sollte sich diese Best-Practice-Länder und deren Wissensvorsprung zum Vorbild nehmen, um die elektronische Patientenakte nach über 14 Jahren des gefühlten Stillstandes auch hierzulande erfolgreich umzusetzen.
The German and Australian healthcare system share extensive similarities in their financial and administrative structures. Both countries follow a two-tiered system offering both public and private insurance. As Germany adapted the Australian DRG system in 2003 to bill patients according to diagnosis-related case rates, patient treatment and accounting also follow similar practices. Despite their common preconditions in the “offline” setting, the goals and execution of their nationally initiated e-health solutions show vast differences. While Australia’s platform-based Personally Controlled Electronic Health Record (PCEHR) offers an opt-in solution for patients and doctors to share healthcare data directly under the control of the patient, Germany’s electronic health card (EHC) mandatorily includes personal and insurance data that can be further expanded with medical data and electronic health records. Information on the EHC is mainly managed by healthcare providers. The differing approaches are linked to different opportunities and weaknesses. This chapter provides a systematic overview of the Australian and German e-health system and gives suggestions on strategies and challenges from both countries. By conducting a SWOT analysis, both e-health systems are critically reflected considering supported processes, applied technologies, and user acceptance. We furthermore discuss the impact of the individual systems on current healthcare issues and the success rate of their initial intentions.
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