Transformationsmodelle einer Bürgerversicherung: Gestaltungsoptionen aus Sicht von Versicherten und Beschäftigten der Krankenversicherungen

Die Segmentierung des deutschen Krankenversicherungsmarktes in die gesetzliche und die private Krankenversicherung gilt seit langem als ordnungspolitisch und gesundheitsökonomisch fragwürdig. Auch sozialpolitisch spricht vieles für eine Bürgerversicherung, weil die Finanzierung des Gesundheitssystems in einem einheitlichen Versicherungssystems solidarischer gestaltet werden kann. In der Studie werden vier unterschiedliche Szenarien einer Bürgerversicherung unter dem Aspekt ihrer Beschäftigungswirkungen untersucht und verglichen. Die Studie soll dazu beitragen, die Beschäftigungswirkungen einer Umgestaltung des Krankenversicherungsmarkes mit dem Ziel einer Angleichung von Wahl-, Wettbewerbs- und Finanzierungsbedingungen fundierter einzuschätzen zu können

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Background: Biological disease-modifying antirheumatic drugs (bDMARDs) used in second-line treatment of rheumatoid arthritis (RA) are administered parenterally. However, so-called targeted synthetic DMARDs (tsDMARDs) – developed more recently – offer alternative (ie, oral) administration forms in second-line treatment. Since bDMARDs and tsDMARDs can be regarded as equal in terms of efficacy, the present study examines whether such characteristics as route of administration drive RA patients’ treatment choice. This may ultimately suggest superiority of some second-line DMARDs over equally effective options, at least according to RA-patient preferences. Objective: The current study assessed the importance of oral administration among other treatment characteristics differing between available second-line DMARDs for RA patients’ preferences using a discrete-choice experiment (DCE). Materials and methods: The DCE involved scenarios of three hypothetical treatment options in a d-efficient design with varying levels of key attributes (route and frequency of administration, time till onset of drug effect, combination therapy, possible side effects), as defined by focus groups. Further patient characteristics were recorded by an accompanying questionnaire. In the DCE, patients were asked to choose best and worst options (best–worst scaling). Results were analyzed by count analysis and adjusted regression analysis. Results: A total of 1,588 subjects completed the DCE and were eligible for final analyses. Across all characteristics included in the DCE, “oral administration” was most desired and “intravenous infusion” was most strongly rejected. This was followed by “no combination with methotrexate” being strongly preferred and “intake every 1–2 weeks” being strongly rejected. On average, levels of route of administration showed strongest influences on patients’ decisions in post hoc bootstrapping analysis. Conclusion: According to the results, an oral DMARD that does not have to be combined with methotrexate and is not administered (only) every 1–2 weeks appears a highly favorable treatment option for patients with RA. DMARDs meeting these preferences may increase compliance and adherence in RA treatment

Healthcare Fact Check: Regional Variations in German Healthcare

Overuse, underuse and misuse in the German health system have been debated by experts for years. The Advisory Council on the Assessment of Developments in the Health Care System called attention to the problem as early as 2001. Valuable resources are used inappropriately and unnecessarily, and often the regional provision of healthcare services and the range of healthcare options offered do not reflect people’s needs

Das Berliner TransitionsProgramm. Sektorübergreifendes Strukturprogramm zur Transition in die Erwachsenenmedizin

The Berlin Transitions Program (BTP) is an interdisciplinary structural program that offers professional case management to help young people with chronic diseases make the transition from pediatric to adult medicine. It is the first program of its kind and serves as a model for a coordinated nationwide transition concept now being reimbursed by a growing number of health insurers

A Stepped Health Services Intervention to Improve Care for Mental and Neurological Diseases: Protocol for a Prospective Cohort Trial

BackgroundMental and neurological disorders cause a large proportion of morbidity burden and require adequate health care structures. However, deficits in the German health care system like long waiting times for access to specialized care and a lack of coordination between health care providers lead to suboptimal quality of care and elevated health care costs. ObjectiveTo overcome these deficits, we implement and evaluate a unique stepped and coordinated model of care (the Neurologisch-psychiatrische und psychotherapeutische Versorgung [NPPV] program) for patients with mental and neurological diseases. MethodsPatients included in the program receive an appropriate treatment according to medical needs in a multiprofessional network of ambulatory health care providers. The therapy is coordinated by a managing physician and complemented by additional therapy modules, such as group therapy, internet-based cognitive behavioral therapy, and a case management. Statutory health insurance (SHI) routine data and data from a longitudinal patient survey will be used to compare the program with regular care and evaluate SHI expenditures and patient-related outcomes. A health care provider survey will evaluate the quality of structure and processes and provider satisfaction. Finally, an analysis of ambulatory claims data and drug prescription data will be used to evaluate if health care providers follow a needs-led approach in therapy. Ethics approval for this trial was obtained from the ethics committee of the chamber of physicians in North Rhine (September 13, 2017, reference No. 2017287). ResultsPatient enrollment of NPPV ended in September 2021. Data analysis has been completed in 2022. The results of this study will be disseminated through scientific publications, academic conferences, and a publicly available report to the German Federal Joint Committee, which is expected to be available in the first half of 2023. ConclusionsThe NPPV program is the first intervention to implement a stepped model of care for both mental and neurological diseases in Germany. The analysis of several data sources and a large sample size (more than 14,000 patients) enable a comprehensive evaluation of the NPPV program. Trial RegistrationGerman Clinical Trials Register DRKS00022754; https://tinyurl.com/3mx9pz5z. International Registered Report Identifier (IRRID)DERR1-10.2196/3756