Biomedical subjects

Reinhard Busse

Publications and source records attributed to Reinhard Busse.

17 recordsLinked to original sources

PubMed2006

[The impact of co-payments on patient behavior: evidence from a natural experiment].

As part of the Statutory Health Insurance Modernization Act a co-payment of 10 Euros per quarter for the first contact at a physician's or a dentist's office has been introduced with effect of January 1, 2004. Apart from contributing to the financial consolidation of the Statutory Health Insurance the co-payment aimed at changing the patients' behavior toward more self-responsibility. This article shows that physician contacts declined in the year 2004 compared to 2003. However, the share of those patients who had at least one physician contact in both years remained stable. Two Logit models point out that necessary physician contacts still take place, e. g., in case of disabled persons and persons with poor health. In addition, no discrimination of persons of low social status could be observed. The results are also approved by other studies. Therefore, it seems plausible, that the introduction of this co-payment has contributed to a reduction of unnecessary and redundant physician visits.

Adult↗

PubMed2006

Hospital case payment systems in Europe.

Since the introduction of the system of diagnosis related groups (DRGs) for USA Medicare patients in 1983, case payment mechanisms have gradually become the principal means of reimbursing hospitals in most developed countries. The use of case payments nevertheless poses severe technical and policy challenges, and there remain many unresolved issues in their implementation. This paper introduces a special issue of the journal that describes and compares experience with the use of case payments for reimbursing hospitals in nine European countries. The editorial sets the policy scene, and argues that DRG systems must be seen both as a technical reimbursement method and as a fundamental incentive mechanism within the health system.

Diagnosis-Related Groups↗

PubMed2006

Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries.

Over the past 20 years, most European countries have introduced DRGs or similar grouping systems as instruments for hospital reimbursement. This paper compares and analyzes the methods used to determine prices for inpatient care within DRGs or similar grouping systems employed in nine EU member states (i.e., Denmark, France, Germany, Hungary, Italy, Tthe Netherlands, Poland, Spain and England). It categorizes the systems of patient classification used in these nine countries and compares them according to the three steps necessary in order to set prices: 1.) definition of a data sample, 2.) use of trimming methods and plausibility checks and 3.) definition of prices. It concludes with a discussion on the typical development path of DRG systems and the role of additional reimbursement components in this context.

Diagnosis-Related Groups↗

PubMed2006

Cost accounting to determine prices: how well do prices reflect costs in the German DRG-system?

Germany has recently introduced a system of Diagnosis Related Groups (DRGs) to engender more appropriate resource allocation. The following article describes the German DRG-system and the methodologies used to determine prices. It analyses the extent to which prices, or calculated cost weights, reflect the actual costs incurred by hospitals for their respective services. We reveal that a "compression" of DRG cost weights occurs, and that the data sample used to calculate cost weights is lacking in terms of its representativeness. Although cost data accuracy has improved over the last few years there are still a number of challenges that need to be addressed.

Accounting↗

PubMed2006

Hospitalisation costs of cystic fibrosis.

OBJECTIVE: To calculate per-case hospital costs for patients with cystic fibrosis under routine conditions from a healthcare provider's perspective; identify the impact of different cost categories; investigate whether cases with cystic fibrosis can be grouped into homogenous cost groups according to defined severity levels; and determine the value of specific factors as predictors of hospital cost variations. METHODS: All data were collected from cases (n = 131) admitted to an inpatient cystic fibrosis unit under routine conditions during a period of 6 months in 2004. All costs were calculated for the year 2004 and divided into categories with high and low impact on variation in hospitalisation costs between patients. Staff costs for patient care, laboratory costs and drug costs were defined as categories with high impact, thus the individual resource utilisation for each case was measured. Cost categories that were classified as having a low impact were measured as overhead costs. Cases were classified according to two different severity models; within each model, patients were classified according to three severity levels. The diagnosis-related model classifies patients with pulmonary hypertension and global respiratory insufficiency as having severe disease, patients with Pseudomonas aeruginosa as having moderate disease, and patients with no colonisation of the lungs as having mild disease. The lung-function-related model differentiates patients as having mild, moderate and severe disease when patients have forced expiratory volumes in 1 second (FEV(1)) that are > or =70%, between > or =40% and <70%, and <40%, respectively. Analysis of variance tests were performed to investigate the differences of mean costs between the groups. Ordinary least squares regression analysis was used to determine predictors for cost variation. RESULTS: The mean total costs per case were 7326 euro. Almost one-third of the total mean costs were attributable to drug costs (28% of total costs), while shares of staff costs for patient care and laboratory costs (both 9% of total costs) were relatively small. Most of the difference in costs between severity levels was attributable to the variation in overhead costs and drug costs. For both severity models differences in mean total costs of mild and severe cases were statistically significant (p < 0.01 and p < 0.05, respectively) when compared with the mean costs of non-mild and non-severe cases. However, in moderate cases, significant differences compared with cases that were not of moderate severity were only seen for certain cost categories. In the multiple regression model the variables 'diagnosis-related severity' and 'FEV(1)' explained 31% of the variance of 'Ln (total costs per case)' between severity levels (p < or = 0.01). CONCLUSION: This study shows that to a large extent hospitalisation costs for patients with cystic fibrosis vary according to the severity of their disease; drug costs play a major role in these differences. In the light of this variation it seems plausible to create separate reimbursement rates for two or three severity groups. Diagnoses as well as FEV(1) seem suitable criteria for such a classification.

Analysis of Variance↗

PubMed2006

[Attempt to exclude invasive cardiology services in Poland--rationing, national sovereignty and European Union law].

One of the guiding principles of health policy in many European countries is equitable access to health care services. One of the life saving procedures is percutaneous transluminal coronary angioplasty (PTCA) performed after coronary angiography. Introducing payment for these procedures would limit access for low-income patients. Fortunately, despite political debate, invasive cardiology develops well in Poland. It is important to notice that within the European Union Polish citizens would be able to receive this treatment in other member states and, according to a European Court of Justice ruling, the costs would have to be reimbursed by the National Health Fund. The wider implication is that the 10 new EU member states now have to realise that health care is no longer a matter of national sovereignty - a fact legislators and health care managers in the 15 member states of the pre-accession EU are still struggling with.

Angioplasty, Balloon, Coronary↗

PubMed2005

The road to reform.

Explore the source record for details and available documents.

Health Care Reform↗

PubMed2005

Analysing the impact of health-care system change in the EU member states--Germany.

The core of the German health-care system is the statutory health insurance (SHI). Coverage of the SHI has remained fairly constant at about 90% whereas the rest of the population is insured for the most part with private health insurance. The primary goal of health-care reforms since the 1990s has been to contain the expenditure of the SHI. The primary measures to do this have been the introduction of budgets and a shift of expenditure towards private households mainly in the form of benefit exclusions and increased co-payments. So far these measures did not have a negative effect on broad outcome measures such as life expectancy, which continued to rise, and self-assessed health of the population, which remained stable in the period 1992--2002. Besides cost containment another leitmotif of reform have been attempts to increase competition both between sickness funds and providers of care. These two strands of reforms also affected the incentive structures for both insurers and providers in various ways which this article describes. The immediate future of health-care reform will concern the mode of financing of the SHI which centres on the question if contributions proportional to income shall be maintained or if there shall be a radical shift towards flat-rate health premiums.

Cost Control↗

PubMed2005

Determining the "Health Benefit Basket" of the Statutory Health Insurance scheme in Germany: methodologies and criteria.

The issue of defining health benefit catalogues has recently gained new importance in Germany as a result of the creation of the new Institute for Quality and Efficiency. The Institute was designed to support the Federal Joint Committee conducting effectiveness studies for benefit coverage decisions. The Committee and the contractual partners (sickness funds and providers) define the benefit catalogues for the Statutory Health Insurance in the framework of Social Code Book V, Germany's most relevant health care scheme. Unlike other countries, the German federal government limits its regulatory role to defining procedures that determine the scope of Statutory Health Insurance services. The explicitness of the benefit catalogues varies greatly between different sectors. While benefits in outpatient care are rather explicitly defined, benefit definitions for inpatient care are vague. It is argued that the establishment of the new Institute and the development of the DRG system are initial steps towards a more effective and explicit benefit catalogue.

Germany↗

PubMed2004

Policies for disease prevention in Germany in the European context: a comparative analysis.

BACKGROUND: In Europe important differences exist concerning policies for the prevention of common diseases. In most cases these cannot be explained by the underlying epidemiology. However, successful policies should have a measurable effect on disease epidemiology. There has been little research comparing the effect of national preventive policies on disease-specific mortality. OBJECTIVES: To describe the mortality trends for three health problems representing the three levels of prevention in Germany and in selected European countries, which are of interest for the disease under question. To relate epidemiological trends to preventive policies at the national level and at the level of the European Union (EU). METHODS: Comparison of age-standardized mortality rates for road traffic accidents, cervical cancer and diabetes mellitus in the period 1970-2002, using routine data. Analysis of disease-specific prevention policies in countries that deviate from the general trend in the EU, with a special focus on developments in Germany. RESULTS: The development of mortality rates during the last 30 years for road traffic accidents, cervical cancer and diabetes mellitus varied substantially across Europe. Although the evidence linking specific public policies to epidemiological trends is sparse and often limited to ecological studies, a number of epidemiological changes can be plausibly linked to specific policies in the countries concerned. CONCLUSION: Successful preventive policies exist for all health problems reviewed. The current status of implementation of these policies can only be interpreted in the historical and political context of the countries concerned. The role of epidemiology to guide health policy decisions is under-utilized, as is the regulatory framework for disease and injury prevention at the level of the EU. Less formal policy measures such as European clinical guidelines are equally scarce. More rigorous comparative health services research is needed to formulate evidence-based policies for disease prevention.

Accidents, Traffic↗

PubMed2003

Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies.

Cystic fibrosis (CF) is the most common life-shortening inherited disease of the Caucasian race, with a prevalence of around 1 in 2500 live births. Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of patients with CF. This article presents an overview of cost-of-illness studies of CF, identifies deficits in the available health economic analyses of CF and discusses which specific factors are essential for the economic evaluation of potential therapies, based on a critical review of the health economic literature on two main therapeutic strategies. Cost-of-illness studies of CF have predominantly been restricted to direct costs. According to the literature, direct costs amount to between 6200- 16300 US dollars (1996 values) per patient per year. As most studies likely underestimated the actual costs (e.g. by disregarding provision of certain healthcare services), real healthcare costs tend to be at the upper end of the cost range. Healthcare costs depend on the patient's age (for adults, costs are approximately twice as high as for children), the grade of severity (the cost relationship of severe to mild CF is between 4.5 and 7.1) and other factors. Lifetime direct costs of CF are estimated at 200 000-300000 US dollars (at 1996 values and a discount rate of 5%). Home intravenous (IV) antibacterial therapy and recombinant human DNase (rhDNase; dornase alfa) treatment are the two main therapeutic strategies most often evaluated in health economic studies of CF. While home IV antibacterial therapy (compared with inpatient IV antibacterial therapy) is assumed to be cost saving, rhDNase treatment is a very cost-intensive therapy intended to efficiently achieve health improvements. Health economic analyses of future CF therapeutic technologies should present explicit data regarding healthcare services provision, resource consumption and unit costs. Indirect costs and patient costs should be considered more often than they have to date, particularly when they are significantly influenced by novel CF technologies. The perspective of health economic studies should be stated explicitly and always include the societal perspective. More economic studies should be based on a controlled, and preferably randomised, design. The observation period must be long enough to identify long-term effects of interventions. A greater number of effectiveness studies should be performed to determine costs and outcomes of therapies applied under everyday life conditions for patients with CF. Finally, international comparison studies should identify the influence of different healthcare systems on the costs and outcomes of interventions.

Anti-Infective Agents↗

PubMed2002

Health target programmes and health care services--any link?: a conceptual and comparative study (part 1).

Against the background of the separation between health policy being concerned mainly with cost-containment on the one hand and the commitment to 'Health for all' based on health target programmes on the other, we undertook a conceptual and comparative study of the policy documents of national and regional health target programmes in countries of the European Union, Australia, Canada, New Zealand and the USA to analyse (1) whether they define objectives for health care; and (2) whether they have a clear orientation towards health outcomes. With the exception of Australia, health target programmes focus on intervention areas outside health services which explains why they remain in the 'forgotten corner' of health policy. Therefore, there is a need to develop an integrated approach, combining health targets for all possible intervention areas including health services, to fully utilise the potential of health target programmes.

Australia↗

PubMed2002

Outcome-related health targets--political strategies for better health outcomes: a conceptual and comparative study (part 2).

Based on an analytical model which defines political co-ordinates on two axes (technocratic-participative and top-bottom), the policy documents of national and regional health target programmes in countries of the European Union, Australia, Canada, New Zealand and the USA are analysed in regard to the rationale for and interest in health targets, the involvement of actors in the policy-cycle, the setting of priorities, the distribution of responsibilities and accountability as well as incentives and sanctions used. Most, if not all, target programmes are conceptualised in a 'top-down' manner by the government and its administration with little involvement of the general public or the parliament. Usually, neither necessary alliances at the grass roots level nor appropriate incentives for local or professional actors are discussed in the documents. Many target programmes are, therefore, bound to fail and finding a balance between the right balance between technocratic and participative as well as between top and bottom remains a challenge for setting successful health targets.

Australia↗

PubMed2002

Low demand for substitutive voluntary health insurance in Germany.

AIM: To examine why the demand for substitutive voluntary health insurance in Germany is low. METHOD: A comparison of the benefits and costs of statutory and voluntary health insurance in Germany, based on a review of literature published in academic journals and books as well as gray literature. RESULTS: Employees in Germany with gross earnings over 40,500 Euros a year can choose to opt out of the statutory health insurance scheme (Gesetzliche Krankenversicherung, GKV) and purchase substitutive voluntary health insurance instead. Only a quarter of these employees and their dependents actually choose to opt out; the majority remain in the GKV. Substitutive voluntary health insurance does not generally afford greater benefits than the GKV in terms of services provided or choice of insurer and only affords marginal benefits in terms of choice of provider. It is also more expensive than the GKV for people with dependents, elderly people and people in poor health. Consequently, the choice to opt out and purchase substitutive voluntary health insurance is more likely to be taken by young, healthy or single people or couples with double incomes. CONCLUSION: Our analysis suggests that the demand for substitutive voluntary health insurance in Germany is low because the costs of opting out of the GKV are, in general, higher than the benefits afforded by purchasing substitutive voluntary health insurance. In the long term substitutive voluntary health insurance does not appear to provide good value for money when compared to the GKV, particularly for people with dependents, elderly people, and people in poor health.

Choice Behavior↗

PubMedDate not supplied

Regulation of pharmaceutical markets in Germany: improving efficiency and controlling expenditures?

Rising pharmaceutical expenditure has become a major concern for policy makers in Germany over recent years. Therefore, the pharmaceutical market has been increasingly targeted by different kinds of regulation, focussing on both the supply and the demand side, using price, volume and spending controls. Specific regulations include price reductions, reference pricing, pharmacy rebates for sickness funds, increasing co-payments, an 'autidem' substitution, parallel imports, a negative list, directives, and finally, spending caps for pharmaceutical expenditure per physicians' association. Although it is difficult to attribute certain effects to single measures, some measures like reference pricing and physician spending caps are more effective and long-lasting than others. In spite of being opposed by physicians, the spending caps applied between 1993 and 2001 have limited pharmaceutical expenditure for an entire decade. However, while some measures do effectively control expenditures, their effect on allocative efficiency may be detrimental.

Cost Control↗

PubMedDate not supplied

Health care reform in Germany: patchwork change within established governance structures.

Under the pressure of health care reform in the 1990s, interactions among the state, sickness funds, and providers in Germany are said to have entered a new era. We examine this new era by assessing both long-term developments connected to German statutory health insurance (SHI) and related short-term developments of the 1990s. Highly institutionalized rules and practices provide little opportunity for abandoning the historical path of two primary factors: the self-governance of SHI and a strong tradition of a semisovereign state. Some opportunities exist for introducing new ideas, rearranging priorities, softening rules, and adding new complex rules and procedures in a fairly fragmented policy-making system, perhaps even because of fragmentation. Yet reforms that depart from the status quo are severely limited by strong legal and administrative traditions and established rules of the game. These restrictions tend to reinforce state intervention, prevent the emergence of consistent and coherent visions of future health policy, and stifle policy innovation and implementation. In sum, reform measures tend to remain well within the priorities established within state and corporatist governance structures.

Cost Control↗

PubMedDate not supplied

Disease management programs in Germany's statutory health insurance system.

The introduction in 1996 of free choice among sickness funds in Germany was accompanied by a "risk structure compensation" (RSC) mechanism based on average spending by age and sex. Because chronically ill people were not adequately taken into account, competition for newly insured consumers concentrated on the healthy. The introduction in 2002 of disease management programs addresses this problem: Insured people in such programs are treated as a separate RSC category, making them a more "attractive" group that no longer generates a deficit. The degree of sickness fund activities and the fierce dispute with physicians are valid indicators that the incentives work.

Chronic Disease↗