PubMed Health⌕ Search

Biomedical subjects

M Geraedts

Publications and source records attributed to M Geraedts.

20 records · Page 2Linked to original sources
PubMedDate not supplied

[Accessibility of doctors' surgeries in Essen, Germany].

BACKGROUND: Constructional barriers often prevent persons who are only partially able, for example those requiring a wheel chair for pre-ambulation, from entering buildings where doctors practise. Even though many international and national resolutions have long been demanding free access to the environment for the partially able, this has not been specially prescribed in Germany. Hence, no one knows anything about outpatient health care facilities in this regard. The present study aimed at analysing accessibility to orthopaedic and neurological practices and surgeries for wheelchair patients. METHOD: We chose Essen, the sixth largest town in Germany, as an example of an urban area, where orthopaedists and neurologists are frequently accessed by wheelchair patients. We performed on-site investigations of the exterior and interior zones of all orthopaedic and neurological surgery buildings in Essen (each n = 29). Criteria for our descriptive analysis were parking lots for the handicapped, shunting areas, entrances at-grade, steps/stories, banisters, ramps, bells and openers of front, elevator and surgery doors, their opening and width. Following the criteria of the DIN 18 024 standard part 2 ("accessibility") the surgeries were divided into four groups 1) fully accessible; 2) slight barriers; 3) considerable barriers; 4) massive barriers. RESULTS: None of the 58 investigated surgeries was fully accessible, 21 of the 29 surgeries of each medical specialty had massive barriers, so that wheelchair patients could access these surgeries only with the help of at least two (strong) persons. Six of the 29 orthopaedic and three of the 29 neurological surgeries had slight barriers, whereas two orthopaedic and five neurological surgeries had distinct barriers. Main barriers were steps in the entrance area; front, elevator or surgery doors too narrow (width less than 80 cm), and elevators too small. DISCUSSION: For wheelchair patients in Germany, free choice of doctors seems to be massively reduced. Since 80 % of orthopaedic and 90 % of neurological surgeries in Essen do not fulfil the quality feature "constructional accessibility", measures that have been taken in the past to help partially able persons to participate in this respective aspect of social life have not been effective. New measures to improve the present situation should be agreed upon by all the institutions involved (politics, local authorities/construction supervision, sickness funds, doctors and associations of sickness fund physicians, and concerned persons). If voluntary measures do not lead to free choice of doctors for wheelchair patients, further legal regulations appear to be mandatory.

Architectural Accessibility↗
PubMedDate not supplied

[Do we really want managed care?].

In spite of the mounting criticism levelled at Managed Care, it is still being discussed in Germany as a promising concept expected to improve both the quality as well as the cost effectiveness of health care. However, this discussion focuses largely on the theoretical advantages of Managed Care in comparison with the German health care system. To examine whether these advantages of Managed Care are actually realised once the concept is broadly implemented, we analysed the contemporary effects of managed care on patients and physicians in the US. This revealed that while Managed Care has for the time being slowed the rise in health services expenditures, major shortcomings of the concept are evident: Patients express a loss of trust in the health care system and complain about decreased choice, poor continuity of care, and persistent high personal health care cost. Physicians complain about increasing financial risks imposed on them, about curtailed therapeutic freedom, and generally the way they must now conduct their medical practice. Law-makers, in turn, react to the defects of the Managed Care industry by imposing increasing external controls and regulations. All in all, Managed Care as implemented by many of the US systems does not appear to fulfill the positive expectations of the two principal stakeholders--patients and physicians. Instead, a large number of side effects are in evidence that appear to make a transfer of the American concept to the German health care system far from desirable.

Cost-Benefit Analysis↗