The influence of the labor market on German health care reforms.

On the surface, the health care systems of Germany and the United States seem to be quite different from each other. However, in both systems, health care financing has close ties to the labor market. Recent changes in Germany's labor market have challenged the traditional employment-based funding of its social health insurance (SHI), to the extent that all political parties advocate decoupling health care financing from labor costs, to various degrees.

Disease management and health care reforms in Germany - does more competition lead to less solidarity?

Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment).

[When is it worth reducing overuse of health care services? The example of prescribing expensive antihypertensives].

Background And Purpose: Reducing overuse of health care services saves costs only if implementation costs are lower than savings from avoided health care services. Predicting the expected net benefit helps policymakers to make a choice among the various overuse problems and components of implementation programs in health care. The goal of this paper is to demonstrate how to calculate the net benefit of reducing overuse.

Technology assessment in dentistry: a comparison of the longevity and cost-effectiveness of inlays.

Objectives: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years.

Impact of demographic changes on healthcare expenditures and funding in the EU.

While there are many international comparisons on the impact of demographic changes on future healthcare expenditures, there are few such comparisons with regard to the impact of demographic changes on future healthcare funding. The purpose of this article is to analyse the impact of demographic changes on healthcare expenditures and funding in 14 selected EU Member States. This article shows that in most countries, healthcare costs per worker are predicted to increase at a faster rate than per capita costs, because workers comprise a decreasing proportion of the total population.

Does prevention save costs? Considering deferral of the expensive last year of life.

Published cost-effectiveness analyses may overstate the cost-effectiveness ratio of preventive care if they do not explicitly model the costs of the last year of life, which is postponed by prevention. To determine the degree of overestimation, the authors built a statistical model using Medicare expenditure data on survivors and decedents. The model shows that the cost-effectiveness ratio of prevention may decrease by up to US$ 11,000 per quality-adjusted life year saved when expenditure data on the last year life are used.

How much does it cost to change the behavior of health professionals? A mathematical model and an application to academic detailing.

Several strategies have shown to be effective at enhancing the implementation of research findings in daily practice. These implementation strategies improve the delivery of preventive or therapeutic care by successfully educating health professionals. On the other hand, little is known about the costs of these implementation strategies.

[At what time is a reduction of medical under- or overtreatment sensible? Treatment of acute depression as an example].

Objective: 1) To portray the mathematical relationship between the size of an underuse or overuse problem caused by non-compliance of health professionals and the cost-effectiveness of a quality improvement program; 2) to demonstrate the applicability of the models to a real-world problem (underuse and overuse in the treatment of major depression) and to stress the importance of the costs of a quality improvement program using this example.

Methods: Mathematical formulation of the relationship between the costs of a quality improvement program and the degree of underuse and overuse.

Results: The example of reducing underuse in the treatment of major depression shows that an intervention with a favorable cost-effectiveness ratio may be economically unattractive if a quality improvement program incurs high costs secondary to a small quality deficit.

Utilitarian theories reconsidered: common misconceptions, more recent developments, and health policy implications.

Despite the prevalence of the terms utilitarianism and utilitarian in the health care and health policy literature, anecdotal evidence suggests that authors are often not fully aware of the diversity of utilitarian theories, their principles, and implications. Further, it seems that authors often categorically reject utilitarianism under the assumption that it violates individual rights. The tendency of act utilitarianism to neglect individual rights is attenuated, however, by the diminishing marginal utility of wealth and the disutility of a protest by those who are disadvantaged.

An evidence-based disease-management program for patients with diabetic nephropathy.

Background: In Germany, a surge in the number of dialysis patients is expected over the next 10 years. This article aims to: (1) address this trend by developing an evidence-based disease-management program for patients with diabetic nephropathy and; (2) to identify areas for future research on disease management tools.

Methods: We conducted a systematic search of studies published between January 1966 and December 2001 investigating the relationship between disease management tools and clinical and economic outcomes of patients with diabetic nephropathy.

When is it worth introducing a quality improvement program? A mathematical model.

Quality improvement programs must compete with other health care interventions for limited health care resources. The goal of the research presented here was to develop a model that portrays the mathematical relationship between the size of a quality deficit caused by the noncompliance of health professionals and the cost-effectiveness of a quality improvement program. The model allows the determination of the minimum size of a quality deficit for which it is worth introducing a quality improvement program.

Appropriateness of invasive cardiovascular interventions in German hospitals (2000-2001): an evaluation using the RAND appropriateness criteria.

Objective: Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart-lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals using RAND appropriateness criteria.

Methods: A retrospective study in 121 randomly selected German hospitals (52% of all hospitals contacted) was performed from December 2000 to August 2001.

An evidence-based evaluation of quality and efficiency indicators.

The goal of this study was to identify and appraise quality and efficiency indicators relevant to hospitals or physicians' practices by performing a systematic literature search. Process indicators were limited to 11 diagnoses and treatments. To appraise the indicators identified, a framework for grading health care recommendations was expanded to categorize evidence on cost-effectiveness.

Inductive reasoning in medicine: lessons from Carl Gustav Hempel's 'inductive-statistical' model.

The purpose of this paper is to discuss both the fundamental requirements of sound scientific explanations and predictions and common fallacies that occur in explaining and predicting medical problems. To this end, the paper presents Carl Gustav Hempel's 'covering-law' model (1948 and 1962) and reviews some of the criticism of the model. The strength of Hempel's model is that it shows that inductive arguments, when applied with the requirement of maximal specificity, can serve as explanations as well as predictions.

A cost-effectiveness model of screening strategies for amblyopia and risk factors and its application in a german setting.

Purpose: To develop a general setting-independent decision-analytical model that determines the costs, effectiveness, and cost-effectiveness of four screening strategies to detect amblyopia or amblyogenic factors in pre-school children and to apply the model in a German setting.

Methods: The general setting-independent decision-analytical model was developed from the perspective of society and the statutory health insurance was developed. Outcomes were the total number of newly detected true positive cases of amblyopia and the costs per newly detected true positive case of amblyopia.

[Cost-effectiveness of quality improvement measures in health care].

Goal: To discuss the costs and cost-effectiveness of quality improvement programs in health care.

Cost Savings Through Quality Improvement: A quality improvement program saves costs if its investment costs are lower than savings from avoiding medical services. Cost savings are most likely realized if a) an overuse or misuse problem is targeted, b) many patients are affected, and c) striving for optimal quality is avoided.