The hospital financing system of the Federal Republic of Germany.

This paper deals with the present hospital financing system of the Federal Republic of Germany. The structure of the financing system is treated as well as the actual financing process, and, as far as possible, both are also quantitatively described. The first section contains a description of the structure, and is concerned with the major institutions participating in the hospital financing - the -the hospitals are described according to ownership, number of beds, specialization, personnel, regional distribution and utilization; - the health insurance system is illustrated by the two major institutions, i.e. statutory and private health insurance agencies, and its effect on hospital financing is explained; - the regulation of the hospital financing system by the federal political system is discussed; - finally, the major economic functions of the institutions involved are sumarized; the interrelations of hospital care and the ambulatory sector are also mentioned. The second section contains a detailed description of the actual financing process, which can be classified according to the sections of financing: - the basic system of the German hospital financing law is introduced; - in the section on investment costs, public grants and their allocation, which are closely related to hospital planning, are discussed; - in the section on operating costs, full cost reimbursement as the basic principle, the structure of costs, the elements and the mechanism of operating cost financing, the actual prices, the financing of private patients' care and special services are described; - a short view of accounting balances, i.e. the differences between cost and financing of hospital services which result in profits or deficits, is given. A few considerations on the evaluation of the financing system conclude the paper

Cognitive-educational treatment of fibromyalgia : a randomized clinical trial : II : Economic Evaluation

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Analyse der Versorgungssitutation von Lungenkrebspatienten anhand von GKV-Routinedaten.

Hintergrund: Trotz der hohen epidemiologischen Relevanz von Lungenkrebs liegen kaum aktuelle Daten zur Versorgungssituation der Betroffenen vor. Die vorliegende Studie nutzt Kassendaten, um die Versorgung von Lungenkrebspatienten und ihre Kosten im Zeitverlauf zu analysieren.   Methoden: Über bundesweite, personenbezogene Leistungsdaten der AOK wurden 2009 17.641 Versicherte mit Erstdiagnose Lungenkrebs identifiziert und über 3 Jahre verfolgt. Dabei wurden sowohl relevante Therapieschemata anhand von GOPs, OPS- und ATC-Codes sowie DRGs nachvollzogen als auch die Kosten, die in den einzelnen Leistungsbereichen der GKV im Kontext von Lungenkrebs entstehen, quartalsbezogen ermittelt.   Ergebnisse: Die Diagnose erfolgte im Mittel mit 68,5 Jahren, ca. 70% der Betroffenen waren Männer. 3.319 Patienten (ca. 19%) überlebten den dreijährigen Beobachtungszeitraum, wobei die Prognose im Fall einer Operation am günstigsten war. Im Zeitverlauf wurden nahezu alle Patienten stationär versorgt, doch nur eine – wenn auch größer werdende – Minderheit ambulant durch Pneumologen (ca. 29%) bzw. Onkologen (ca. 17%) betreut. Die lungenkrebsassoziierten Ausgaben waren im Diagnosequartal am höchsten und sanken sukzessive auf ca. 20% des Ausgangswerts. Maßgeblich hierfür war ein substantieller Rückgang der Kosten im stationären Bereich.   Diskussion: Kassendaten erlauben bei geeigneter Operationalisierung eine umfassende Analyse der Versorgung von Lungenkrebspatienten innerhalb des GKV-Systems. Hierbei zeigt sich, dass die Betroffenen insbesondere in der Anfangsphase vorwiegend (teil)stationär versorgt werden. Die ambulante onkologische Betreuung spielt insgesamt eine eher untergeordnete Rolle, allerdings wächst ihre relative Bedeutung für die Lungenkrebstherapie im Zeitverlauf. Inwieweit diese Strukturen und die aus ihnen resultierenden Versorgungskosten medizinisch angemessen sind, ist in weiteren Studien zu erforschen

Der Bayern-Vertrag im Spiegel ärztlicher Meinungen.

Among the attempts at cost containment the so-called 'Bavarian Agreement' represented a special variation: the practising physicians were called upon to reduce the frequency of cost-intensive prescriptions, such as referring their patient to a hospital. An analysis of the structural factors governing the medical care system and of the reactions on the part of the doctors shows the obstacles confronting the agreement and also why the agreement was not as successful as originally intended as far as cost containment was concerned

Cost-components of lung cancer care within the first three years after initial diagnosis in context of different treatment regimens.

Objectives: Although lung cancer is of high epidemiological relevance in Germany, evidence on its economic implications is scarce. Sound understanding of current care structures and associated expenditures is required to comprehensively judge the additional benefit of novel interventions in lung cancer care. Adopting a payer perspective, our study aims to analyze expenditures for individuals with incident lung cancer. Material and methods: Patients with an initial diagnosis of lung cancer (ICD-10 code C34) in 2009 were searched in a large, nationwide base of health insurance claims data and grouped according to initial treatment (Surgery, Chemotherapy/Radiotherapy, No specific treatment). All-cause SHI and lung cancer-related spending was assessed for a patient-individual three-year time frame after initial diagnosis. Expenditures per case and expenditures per year survived were calculated via Generalized Linear Gamma Models adjusted for age, gender, living region, baseline metastases, multiple tumors and initial treatment regimen using time under observation as a weighting factor. Results: 17,478 individuals were identified. Lung cancer-related expenditures peaked within the first six months after initial diagnosis. Following, they declined subsequently and so did their share in all-cause SHI spending. Lung cancer-related expenditures per case were estimated at €20,400 (53% of all-cause expenditures) with a huge variance according to initial treatment regimen [Surgery: €20,400, Chemotherapy/Radiotherapy: €26,300, No specific treatment: €4200]. Cost per year survived amounted to €15,500 (55% of all cause expenditures) [Surgery: €11,600, Chemotherapy/Radiotherapy: €20,200, No specific treatment: €7600]. Conclusion: Analyses of lung cancer-related expenditures need to take into account treatment strategies and survival. Our study is representative for a large share of the population and provides detailed, patient-level information on costs of care and their compilation. Results render estimates available for the cost of lung cancer e.g. for budget impact analyses, cost-effectiveness analyses of screening and prevention schemes, or prognostic models of life-time expenditures per lung cancer case

Hospital care for persons with AIDS in the European Union

This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMHICT-941723). In collaboration with another EU- project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contacts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10 000-12 700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach

Holism in sports coaching: Beyond humanistic psychology: A commentary

Increasingly the professional development literature in sports coaching encourages coaches to coach holistically. Yet the phrase ‘holistic coaching’ is mired in ambiguity and has the potential to become meaningless. The aims of this article are to explore the relationship between holism, humanistic psychology, humanism and sports coaching, and to pose some challenges, which could support the field to move beyond the influence of humanistic psychology. © Multi-Science Publishin