Kundenbindung und Wechselverhalten in der privaten Krankenversicherung

Hodek J-M. Kundenbindung und Wechselverhalten in der privaten Krankenversicherung. Göttingen: Cuvillier; 2010

Brand building in hospital sector

Hodek J-M, Gramsch A, Greiner W. Brand building in hospital sector. BETRIEBSWIRTSCHAFTLICHE FORSCHUNG UND PRAXIS. 2009;61(3):254-270

Relationship Between Health-Related Quality of Life and Multimorbidity

Hodek J-M, Ruhe A-K, Greiner W. Gesundheitsbezogene Lebensqualität bei Multimorbidität. GESUNDHEITSWESEN. 2010;72(08/09):455-465.Objectives: Changed morbidity patterns in many industrialised countries lead to new requirements concerning the health-care process. In contrast to a complete cure and due to increasing (multiple) chronic conditions with longevity, the alleviation of complaints and thereby securing the health-related quality of life (HRQoL) is coming more and more into the focus of efforts. The objective of this review is to analyse the effects of (multiple) chronic conditions on HRQoL. Another aim is to ascertain to what extent the number and specific combination of conditions have an impact on HRQoL. Methods: This review is based on a systematic literature search using MeSH terms in Medline/Pubmed and several publisher databases. Inclusion criteria focus particularly on the relationship between multimorbidity and HRQoL. Results: Findings of the literature search clearly show that existing chronic conditions have a negative impact on HRQoL. Most studies conclude that the quality of life decreases with an increasing number of diseases. In comparison to mental or social dimensions, the inverse relationship between multimorbidity and HRQoL is significantly stronger in physical dimensions. Particularly cardiovascular diseases and musculoskeletal disorders result in severe losses of HRQoL. Furthermore, the HRQoL is reduced by specific disease combinations. Patterns of disease combinations influence the degree of HRQoL loss, as well. Conclusion: A clear understanding of the impacts of multimorbidity and specific morbidity patterns on the different dimensions of HRQoL can help to optimise the health-care process for the patients benefit. This optimised process should not separate between single diagnoses, but focus on the concurrence of multiple conditions having regard to patient-relevant outcome HRQoL. For example, one potential is to focus efforts on key conditions in the cooccurrence of multiple diseases (like musculoskeletal disorders). The current state of research on specific morbidity patterns and their impacts on HRQoL is limited. Especially for the German-speaking areas further analyses are needed

Relationship between multimorbidity and direct healthcare costs in an advanced elderly population

Nagl A, Witte J, Hodek J-M, Greiner W. Relationship between multimorbidity and direct healthcare costs in an advanced elderly population. Zeitschrift für Gerontologie + Geriatrie. 2012;45(2):146-154.The goal of this work was to analyze the impact of the extent of multimorbidity on health service resource utilization and, thus, direct healthcare costs of advanced elderly in the German population. Based on a cross-sectional sample aged 72 or above in Germany (n = 1,937), a bottom-up study assessing resource utilization and corresponding costs was performed. Main data sources were patient-reported information concerning morbidity and health service resource utilization administered via telephone interviews within the framework of the PRISCUS trial. To value resource utilization, unit costs were determined for all services under consideration. In order to estimate the impact of multimorbidity on mean annual direct costs, a cumulative multimorbidity index was constructed. Influencing factors on annual average costs were identified via multivariate linear regression models. Mean annual direct costs of 3,315 EUR (95% confidence interval (CI) 3,118; 3,512) at 2010 prices were caused by the involved patients: 25% of mean annual costs were due to inpatient care, 20% to outpatient physician services, 20% to pharmaceuticals, 12% to assisted living and transportation, 8% to healthcare products and dentures, 7% to rehabilitation services, 5% to outpatient nonphysician providers, and 3% to spending from compulsory long-term care insurance. Each additional comorbidity was accompanied by a cost increase of 563 EUR (95% CI 488; 638). Participants with no diseases mentioned in the multimorbidity index caused average annual costs of 1,250 EUR. In contrast, respondents with 10 + diseases caused the highest mean annual costs of 6,862 EUR. Longer life expectancy has become commonplace and is often associated with the simultaneous occurrence of several diseases. A clear understanding of the impact of multimorbidity on costs is highly relevant for health policy decision makers. The present study provides a well-founded basis to analyze the relationship between multiple morbidity and associated costs due to healthcare resource consumption of older adults in Germany

Nutzen und Kosten der derzeitigen Regulierung des Apothekenmarktes in Deutschland

The pharmacy sector in many European countries continues to be subject to strict governmental regulations. This consists - depending on the country - of regulations on ownership, business operations, opening hours, personnel, pricing, prohibiting certain sales methods (e.g. mail order), and specifying product ranges. Indeed, Germany has a particularly strong conglomeration of regulations. Specific governmental interventions on the marketplace, i.e. interventions additionally to general legislation governing the organisation of markets in terms of regulatory policy, are frequently justified as being peculiarities of the market, which actually or allegedly prevent the market mechanism from achieving optimal results. The aim of specific interventions is to eliminate the negative consequences of free competition. However, the resulting benefits always have to be offset by the costs of regulation. These costs consist first of direct costs due to the regulation itself, since they restrict the freedom of potential suppliers and/or customers. Secondly, they have indirect welfare effects, referred to by the term "excess burden". This can be illustrated by the example of taxation: taxes are used to fund the affairs of the country. However, they place a direct burden on the taxpayers, but they also cause taxpayers to adapt, e.g. by being less willing to work, thereby costing the national economy the "excess burden". This study analyses these benefits and costs of regulation in the German pharmacy sector. It then describes the deregulation measures needed to avoid regulation-costs to the national economy. The main outcome lies in the conclusion that partial deregulation is capable of improving efficiency and quality in drug distribution. Based on the principle of "value for money", quality improves with a given investment in drug distribution. In contrast to the present situation, Germany could be a pioneer with regard to the regulation of the pharmacy sector, focusing on the interests of consumers and patients - and not just on particular interests specific to the profession. On basis of economic theory of production and transaction-cost regarding economies of scale and economics of scope as well as on basis of welfare economics regarding oligopoly models, this analysis is coming to the result that particularly ownership and management regulations of German pharmacy sector are not only obsolete, but impose high costs on society. Together with a partial relaxation in the field of business operations and product ranges - in this part less regulatory interventions and thus the power of free competition can cause at least the same results as the present strong regulation. And this without raising a danger for customers - a wide deregulation can develop positive economic effects. Additional or even stronger effects will be possible, if price regulations and mail-order-regulations are deregulated, too. However, the analysis also shows that not every regulatory measure in the pharmacy sector should be discarded. This includes pharmacy-only and prescription-only rules, the duty that a pharmacy must be managed by a pharmacist (which must be distinguished from the ownership of a dispensary) and some of the business regulations as well as minimum opening hours. Economic potential can be realised by allowing more competition in the pharmacy sector. The more of mentioned deregulation can be realised, the larger positive economic effects can be attained. Long-term consequence of initiated trial and discovery procedures with different concepts of vertical or horizontal cooperation could be a coexistence of owner-operated pharmacies and those owned by larger joint-stock companies, which increases national welfare by meeting society-s preferences.Apothekenregulierung, Gesundheitsökonomie, pharmacy market regulation, health economics

Determinants of Willingness to Pay for a New Therapy in a Sample of Menopausal-Aged Women

Background: Menopause is a natural physiological event that usually begins in women between the ages of 48 and 55 years. In many cases, this event is associated with unpleasant somatic-vegetative, urogenital or psychological symptoms. Objective: To test the health and social demographic factors (especially household income level) that influence willingness to pay (WTP) for a new hormone-free treatment in women of menopausal age. Methods: 1365 women between the ages of 45 and 73 years were surveyed about their health and WTP for the new treatment. WTP was evaluated with a closed-ended binary questionnaire (four groups with different levels of co-payment between €15 and €60), using the contingent valuation method. The average WTP was calculated according to the area under the demand function. Factors contributing to payment readiness were examined by means of binary logistic regression. Results: WTP was significantly affected by women's opinion of the new medication, the level of co-payment required, net household income, whether currently in treatment for menopausal symptoms, and Menopause Rating Scale (MRS) values. Compared with other factors, the level of co-payment was predicted to have a negative impact on WTP. Income level is an important factor in WTP and correlates highly with several other health-related variables (WHO-5 index, MRS value, receipt of other menopause medicines and existing co-morbidity). The average co-payment that our group of women was willing to pay was between €17 and €35 per month, or €24 to €42 for women who were currently receiving treatment for symptoms of menopause. While interpreting the results, it should be considered that the hypothetical therapy was assumed to be a new non-reimbursable alternative to conventional therapy offered under the existing statutory framework for health insurance in Germany. Conclusions: Despite some methodological limitations, these results are useful for examining the factors affecting WTP and incremental utilities for future medicine dealing with menopause.

MEASURING ECONOMIC CONSEQUENCES OF PRETERM BIRTH - METHODOLOGICAL RECOMMENDATIONS FOR THE EVALUATION OF PERSONAL BURDEN ON CHILDREN AND THEIR CAREGIVERS

Hodek J-M, Mittendorf T, von der Schulenburg MG. MEASURING ECONOMIC CONSEQUENCES OF PRETERM BIRTH - METHODOLOGICAL RECOMMENDATIONS FOR THE EVALUATION OF PERSONAL BURDEN ON CHILDREN AND THEIR CAREGIVERS. Acta Paediatrica. 2010;99(462):98

Finanzmanagement in Arztpraxen und Ärztenetzen

Greiner W, Hodek J-M. Finanzmanagement in Arztpraxen und Ärztenetzen. In: Busse R, Schreyögg J, Tiemann O, eds. Management im Gesundheitswesen. 2nd ed. Berlin: Springer; 2010: 248-258

Voraussetzungen für ein neues Gesundheitsversorgungsmodell für ältere, multimorbide Patienten: Forschungsverbund PRISCUS

Thiem U, Theile G, Junius-Walker U, et al. Prerequisites for a new health care model for elderly people with multimorbidity: The PRISCUS research consortium. Zeitschrift für Gerontologie + Geriatrie. 2011;44(2):115-120

Determinants of Willingness to Pay for a New Therapy in a Sample of Menopausal-Aged Women

Rasch A, Hodek J-M, Runge C, Greiner W. Determinants of Willingness to Pay for a New Therapy in a Sample of Menopausal-Aged Women. PHARMACOECONOMICS. 2009;27(8):693-704.Background: Menopause is a natural physiological event that usually begins in women between the ages of 48 and 55 years. In many cases, this event is associated with unpleasant somatic-vegetative, urogenital or psychological symptoms. Objective: To test the health and social demographic factors (especially household income level) that influence willingness to pay (WTP) for a new hormone-free treatment in women of menopausal age. Methods: 1365 women between the ages of 45 and 73 years were surveyed about their health and WTP for the new treatment. WTP was evaluated with a closed-ended binary questionnaire (four groups with different levels of co-payment between is an element of 15 and is an element of 60), using the contingent valuation method. The average WTP was calculated according to the area under the demand function. Factors contributing to payment readiness were examined by means of binary logistic regression. Results: WTP was significantly affected by women's opinion of the new medication, the level of co-payment required, net household income, whether currently in treatment for menopausal symptoms, and Menopause Rating Scale (MRS) values. Compared with other factors, the level of co-payment was predicted to have a negative impact on WTP. Income level is an important factor in WTP and correlates highly with several other health-related variables (WHO-5 index, MRS value, receipt of other menopause medicines and existing co-morbidity). The average co-payment that our group of women was willing to pay was between is an element of 17 and is an element of 35 per month, or is an element of 24 to is an element of 42 for women who were currently receiving treatment for symptorns of menopause. While interpreting the results, it should be considered that the hypothetical therapy was assumed to be a new non-reimbursable alternative to conventional therapy offered under the existing statutory framework for health insurance in Germany. Conclusions: Despite some methodological limitations, these results are useful for examining the factors affecting WTP and incremental utilities for future medicine dealing with menopause