Health Economic Aspects Of Chronic Care an der Universität zu Köln

Karteikarten und Zusammenfassungen für Health Economic Aspects Of Chronic Care an der Universität zu Köln

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Lerne jetzt mit Karteikarten und Zusammenfassungen für den Kurs Health Economic Aspects Of Chronic Care an der Universität zu Köln.

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Risk Adjustment Scheme (RSA)

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Which are the main medical problems that are often overlooked in old age?

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Characteristics of the German health care system

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

What are the challenges in chronic care for the elderly? 

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

How should the healthcare system be organized to provide chronic care for the elderly?

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Primary care treaties (§ 73b SGB V)

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Actual treatment shift

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Elements of primary care treaties

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

What is competition among SHI good for?

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Which are the main requirements for competition among SHI?

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Which one is the most common type of IC contract in SHI?

Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Innovation Fund

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Beispielhafte Karteikarten für Health Economic Aspects Of Chronic Care an der Universität zu Köln auf StudySmarter:

Health Economic Aspects Of Chronic Care

Risk Adjustment Scheme (RSA)

Aim: enable competition between statutory health insurers

Until 2002 mainly based on income, age and gender. This led to wrong incentives towards selecting „healthy“ target groups. RSA reform in 2002 aimed to increase activities to develop patient oriented services (=DMP) for chronically ill insurees. Direct financial compensation based on avarage costs of enrolled chronic patients (~ 1.300 € additional reimbursement). Health Insurers with higher share of e.g. diabetics benefit. > Morbi-RSA since 2009: DMP link determined. Instead: 80 conditions relevant for „morbidity oriented“ RSA (DMP conditions included, independent of DMP participation). Remaining: DMP fee to compensate program costs (~ 145 € pp.)

Health Economic Aspects Of Chronic Care

Which are the main medical problems that are often overlooked in old age?

  • dementia
  • depression
  • incontinence
  • malnutritio
  • exsiccosis
  • anaemia
  • falls
  • decreasing performance of sensory organs
  • dental problems
  • adverse medication effects

Health Economic Aspects Of Chronic Care

Characteristics of the German health care system

  • „conservative model” of social security (Esping-Andersen 1990)
  • mix between public and private financing and provision of care
  • constituent part is the statutory health insurance (SHI), mandatory for „vulnerable” part of the German population (Bismarck 1883)
  • SHI covers around 60 percent of health care costs in Germany
  • examples for private elements: e.g. private insurance for not mandatory SHI insured, for profit health provision and services
  • public elements: e.g. hospital investment costs by states; coverage for civil servants
  • solidarity principle in SHI: every member pays a fixed percentage of income (not economically active family members are free)
  • solidarity from singles to families, high income to low income; young to old, men to women
  • traditionally many types of SHI (AOK, IKK, BKK, EK etc.), concentration from ~ 20.000 organizations (1900) to ~ 100 (2019)
  • free choice of SHI company for every member since 1996 (enrolment obligation for SHI) > competition!

Health Economic Aspects Of Chronic Care

What are the challenges in chronic care for the elderly? 

  • 50 % of older adults with 3 or more chronic conditions
  • effect of multimorbidity is cumulative on individual
  • CPG focus on single disease
  • lack of evidence (clinical studies)
  • interaction among conditions
  • patient’s preferences are often not known/considered

Health Economic Aspects Of Chronic Care

How should the healthcare system be organized to provide chronic care for the elderly?

  • Pro-active vs. re-active care
  • algorithms of secondary prevention and symptoms can both trigger care
  • cross-sectoral and “life spanning” not episode-based care
  • “holistic” care
  • empowered patients

Health Economic Aspects Of Chronic Care

Primary care treaties (§ 73b SGB V)

Introduced in 2004 with obligation for SHI to offer PC models (primary care model; Hausarztmodell) to their insurees. 

  • In 2004 only possible with KV, no budget clearing of/seed funding
  • Consequence : most treaties were closed as primary care based integrated care according to § 140a (litigation won by KV in 2008)
  • Since 2009 obligatory contracting with professional association (HÄV)

> Primary Care Treaties may not be efficient as a “stand alone model”, but as one important element in an Integrated Care Setting.

Health Economic Aspects Of Chronic Care

Actual treatment shift

from inpatient to outpatient (requires organizational changes in participation hospitals)

Health Economic Aspects Of Chronic Care

Elements of primary care treaties

  • Family practitioner as a „guide“ and „ gatekeeper“
  • Access to medical care only via selected family practitioner (except for emergencies)
  • Voluntary participation for patients; commitment period 1 year
  • Incentive: bonus, e.g. reduction of copays (e.g. Praxisgebühr)

Health Economic Aspects Of Chronic Care

What is competition among SHI good for?

  • driver of improvement of quality, structures and processes (instead of legal directives)
  • warranty and increase of effectiveness and efficiency
  • securing patient participation on progress and innovation in medical treatment
  • adherence to financial framework

Health Economic Aspects Of Chronic Care

Which are the main requirements for competition among SHI?

  • „fair” competitive order, especially compensation of different risk structure of insured population between sickness funds (RSA scheme)
  • prevention of lack incentives like e.g. risk selection of young and healthy members (“cream skimming”)
  • “Solidarian Order of Competition”

Health Economic Aspects Of Chronic Care

Which one is the most common type of IC contract in SHI?

hip/knee replacement surgery

Health Economic Aspects Of Chronic Care

Innovation Fund

  • External financing and incentives for implementing new projects (300 million € yearly for 4 years: 225 Mill. €/year for new models of healthcare & 75 Mill. €/year for health care research)
  • Collective and transparent evaluation of medical and economic benefits to decide about integration in „usual care“ after the project period (3 years)
  • Decision making by the „Joint Innovation committee“ (G-BA + ministry), consulted by „expert advisory group“
  • Aim: improvement of cross sectoral quality of care in the SHI (process innovation, not product innovation)

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