Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract.

Introduction: Integrated care solutions need supportive financial incentives. In this paper, we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal.

Description Of Integrated Care Case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications.

[Aims of the health system modernisation act (GMG) from a medical point of view].

Like all its predecessors the Health System Modernisation Act (GMG) means to preserve solidarity-based statutory health insurance and to ensure a sufficient, appropriate and efficient treatment of all patients. The instruments are higher co-payments from patients (such as practice fees), cost containment through exclusion of certain services, and more competition. Competition is supposed to be encouraged through new forms of care.

[Networking: ambulatory and stationary mesdical care].

A better co-operation between health care sectors and primary and specialised treatment levels is inevitable for ensuring good patient care. Many informal co-operations already exist, and their experience may be used for developing new forms of co-operation. Therefore, the existing legal basis has to be changed, barriers must be abolished and new incentives established.

[Networking physicians' practices: teleconsultation/teleconferencing].

Tele-medicine offers clear possibilities to improve the work of the doctor, in order to ensure the optimal treatment of the patient. In particular, cooperation between outpatient and inpatient doctors can be organised more efficiently using new forms of communication and information via the electronic network and EDP-based information processing. Problems with the utilisation of tele-medicine lie in both the design of the fundamentals and standards with regard to legal unity as well as in a lack of knowledge of many doctors in the utilisation of these new techniques.

[Health care contract, economic options and budgeting in ambulatory care].

At the beginning the principle of profitability (sufficient, suitable, economical, necessary) and its effects on medical action are analysed. An explanation is given why the appointed doctors cannot provide medical care satisfactorily in a budgeted system under mere economical criteria. The budget leads to rationing and quality reduction and leaves no scope for medical progress.

[Medical discretion towards relatives, colleagues and the media from the physician's point of view].

Three aspects are examined more closely: discretion towards relatives, medical colleagues and the media. Medical discretion has a long tradition and forms an indispensable part of the medical ethos. Physicians, however, often find it difficult to cope with the diversity of legal regulations.

[Billing fraud from the viewpoint of the federal health insurance society].

During the past ten years, there has been a controversy among the German registered physician about settlement fraud-then outraged, now calling for criminal proceedings and an investigation by the public prosecutor. This is due to the fierce competition in a system of dense medical representation. Economically, any settlement fraud in the compulsory health insurance damages the colleagues, not the health insurance.

[Experience with a one-stage hypospadias repair (author's transl)].

33 single-stage hypospadias repairs are reported, which were performed within 2 years. The operative technique is described. In two cases, fistulas developed and required operative treatment.

[Comparative investigations in closing nephrotomies with conventional suturing technique and dura ribbons (author's transl)].

On 13 rabbits total longitudinal nephrotomies were performed on both kidneys. On the right side the margins of the parenchyma were sutured together with figure eight sutures. On the left, the nephrotomies were closed by tying ribbons of human dura around the kidney.

[Varicocele as a cause of disorder in fertility (author's transl)].

In this study the pathophysiological connections in varicocele genesis are discussed, as well as its effect upon spermiogenesis and the causal factors. In 73 patients the high retroperitoneal ligature of the testicular vein was performed. Indication was given either on the basis of subjective complaints or on the proof of subfertility.

Replacement of tunica albuginea of corpus cavernosum penis using human dura. Experimental study on dogs.

The tunica albuginea of corpus cavernosum penis was excised and replaced with human dura in experiments on 11 dogs. The surface of the implant epithelialized within three weeks, and later the implant was replaced by autologous tissue with no scarring and shrinkage. After resection of placques in Peyronie's disease the tunica albuginea can be replaced with specially treated human dura.