scholarly journals Statin-associated myopathy. Assessment of frequency based on data of all statutory health insurance funds in Germany

2018 ◽  
Vol 6 (3) ◽  
pp. e00404 ◽  
Author(s):  
Peter Ihle ◽  
Franz-Werner Dippel ◽  
Ingrid Schubert
Keyword(s):  
Health Insurance ◽  
Statutory Health Insurance ◽  
Insurance Funds ◽  
Health Insurance Funds

scholarly journals On the slow implementation of pilot projects: Suspected causes from the perspective of statutory health insurance funds / Zur zögerlichen Umsetzung von Modellvorhaben: vermutete Ursachen aus Sicht der gesetzlichen Krankenkassen

2018 ◽  
Vol 5 (1) ◽  
pp. 64-71
Author(s):  
Michael Wessels ◽  
Dorith Geuen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Statutory Health Insurance ◽  
Insurance Companies ◽  
Care Providers ◽  
Pilot Projects ◽  
Insurance Funds ◽  
Health Insurance Companies ◽  
The Law ◽  
Health Insurance Funds

Abstract Background The system of nursing care in Germany is currently changing. For years, a further development of cooperation in the health care sector has been discussed. And thus a change in the distribution of tasks between health care professions. In 2008, the legislature introduced the introduction of pilot projects for the transfer of medicinal tasks to nurses according to § 63 para. 3c Social Code V. The implementation is very sluggish. The aim of the study was to analyze the reasons for this sluggish implementation from the perspective of the statutory health insurance funds. Methods Quantitative survey of all statutory health insurance funds (n=124) in Germany. Results To ensure supply, 94 % of health insurance companies consider the transfer of medical tasks to non-medical care providers as a sensible approach. Also 96 % consider this to be very important in order to ensure care. Although 96 % of health insurance funds support the implementation of pilot projects, only 8 % are in fact involved in such contracts; 71 % do not plan own pilot projects for the future. In the view of the statutory health insurance funds, legal obstacles (90 %), resistance by medical representatives (84 %), unresolved financing (74 %) and liability issues (70 %) as well as non-applicable regulations in G-BA-directive (79 %) and the law (85 %). Less than half (46 %) of the health insurance companies suspect high costs causing the slow implementation. Discussion The amendments adopted by the legislature in the current reform of the law on care professions can be described as appropriate; in particular the fact that statutory health insurance funds should implement and carry out appropriate pilot projects by 31 December 2020.

Beitragssatz, Kassenwettbewerb und Gesundheitsreform / Premium Rates, Competition Among Health Insurance Funds and the Health Care Reform 2007

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Hanfried H. Andersen ◽  
Markus M. Grabka ◽  
Johannes Schwarze
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Reform ◽  
Statutory Health Insurance ◽  
New Products ◽  
Panel Study ◽  
Multinomial Logit Model ◽  
Insurance Funds ◽  
Premium Rates ◽  
Health Insurance Funds

SummaryThe premium rates paid for statutory health insurance in Germany play a key role in the competition among health care funds. With the most recent health care reform (GKV-Wettbewerbsstärkungsgesetz GKV-WSG), a range of new products have been introduced that could erode the advantageous selling proposition of the premium rates. In addition to the pure monetary incentive to change health insurance provider, the new products include aspects that are becoming increasingly important to insured persons, such as the assessment of their own morbidity and the level and quality of health care provision. We find that current morbidity, experiences in morbidity, and expectations about morbidity will gain in importance when choosing health care provider.Using micro-data for the years 1999 to 2004 from the German Socio-Economic Panel study (SOEP), we investigate the willingness to change health provider in a multivariate setting. The SOEP data will be matched with register information about premium rates of all statutory health insurance funds in Germany. Applying a multinomial logit model, we show that there are two prototypes of insured people who change funds. The characteristics of those who changed funds can be used to evaluate the future developments in statutory health insurance in Germany, assuming that customer mobility will continue to increase.

Charter of the Kazan Society of Physicians for the provision of medical care to participants in the sickness funds established by law on June 3, 1912

1913 ◽  
Vol 13 (2) ◽  
pp. 91-110
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Medical Assistance ◽  
Medical Aid ◽  
Insurance Funds ◽  
The Law ◽  
Health Insurance Funds ◽  
The City

The Kazan Society of Physicians for the Provision of Medical Aid to the Participants of the Health Insurance Funds Established on the Basis of the Law of June 23, 1912 "has the goal of providing medical assistance to the participants of the Health Insurance Fund established on the basis of the Law of June 23, 1912 in the city of Kazan and its environs.

scholarly journals Information Needs of Patients Undergoing Bariatric Surgery in Germany: A Qualitative Interview Study

2021 ◽  
Author(s):  
Jessica Breuing ◽  
Nadja Könsgen ◽  
Katharina Doni ◽  
Annika Lena Neuhaus ◽  
Dawid Pieper
Keyword(s):  
Bariatric Surgery ◽  
Health Insurance ◽  
Support Groups ◽  
Information Needs ◽  
Information Dissemination ◽  
Information Provision ◽  
Nutritional Counseling ◽  
Qualitative Interview Study ◽  
Insurance Funds ◽  
Health Insurance Funds

Abstract BackgroundObesity is a worldwide problem with different treatment options. Bariatric surgery is an effective treatment for severe obesity; however, it leads to drastic changes (e.g., changes in everyday life and eating behavior) for patients, which may lead to information needs. Our aim was to identify the information needs of patients undergoing bariatric surgery and to explore the information provision within the healthcare process of bariatric surgery in Germany.MethodsWe conducted n=14 semi-structured telephone interviews between April 2018 and April 2019. The interview guide was designed prior to the interviews and consisted of 4 main sections (demographic information, pre- and postoperative healthcare provision, information needs). The audio-recorded interviews were transcribed verbatim and analyzed using qualitative content analysis with MAXQDA software.ResultsThere were unmet information needs with two factors (time: pre/postoperative and categories of information: general/specific) to be considered. Due to the patients’ description of information, we categorized information into general (different surgical procedures, general nutritional information) and specific (occurring simultaneously with a problem) information. Most patients felt well informed concerning general information. However, it was pointed out that it was not possible to provide complete information preoperatively, as the need for information only arises when there are postoperative (specific) problems. In addition, there seems to be a high demand for specific postoperative information regarding nutrition and nutrition-related problems. However, patients stated that postoperative nutritional counseling is not reimbursed by health insurance funds. The information conveyed in support groups and the exchange of experiences are highly valued by patients. However, some patients describe the information provided within the support groups as unfiltered, frightening or exaggerated.ConclusionOverall, there were unmet information needs. Reimbursement by health insurance funds could increase the use of postoperative nutritional counseling and thus serve existing information needs. Support groups enable an exchange of experiences and therefore offer low-barrier access to information. Cooperation between support groups and healthcare professionals in information provision could be an approach to improving existing information needs or to avoiding the development of information gaps. Furthermore, the development and implementation of a digital solution for (postoperative) information dissemination could be helpful.

Gemeinsame Selbstverwaltung: Bedingungen der Aufgabenwahrnehmung

2019 ◽  
Vol 68 (6-7) ◽  
pp. 519-536
Author(s):  
Thomas Gerlinger
Keyword(s):  
Health Insurance ◽  
Medical Profession ◽  
Insurance Companies ◽  
Regulatory Change ◽  
Self Administration ◽  
Insurance Funds ◽  
Health Insurance Companies ◽  
Joint Federal Committee ◽  
Health Insurance Funds ◽  
Regulated Competition

Zusammenfassung Ein vielgestaltiger Wandel in Gesundheitssystem und Gesundheitspolitik erschwert den Verbänden der Ärzte und Krankenkassen die Wahrnehmung ihrer Aufgaben im Rahmen der gemeinsamen Selbstverwaltung. Erstens steigert die mit der Einrichtung des Gemeinsamen Bundesausschusses verbundene transsektorale Ausweitung der korporatistischen Verhandlungssystemen die Komplexität der Akteurs- und Interessenkonstellationen in der gemeinsamen Selbstverwaltung. Zweitens trägt der ordnungspolitische Wandel in Richtung auf einen regulierten Wettbewerb zu einer Binnendifferenzierung der Interessen in der Ärzteschaft und bei den Krankenkassen bei. Drittens erschwert auf der Seite der Ärzteschaft zusätzlich die Ausdifferenzierung von Disziplinen, Versorgungseinrichtungen und -formen sowie von beruflichen Identitäten die für das Funktionieren der gemeinsamen Selbstverwaltung erforderliche Aggregation von Interessen und die Kompromissfindung. Abstract A multi-faceted change in the health system and health policy makes it difficult for associations of doctors and health insurance companies to carry out their tasks within the framework of joint self-government. First, the transsectoral expansion of corporatist bargaining systems associated with the establishment of the Joint Federal Committee increases the complexity of stakeholder and stakeholder constellations in joint self-government. Second, regulatory change towards regulated competition contributes to an internal differentiation of interests in the medical profession and in the health insurance funds. Third, on the side of the medical profession, the differentiation of disciplines and care as well as of occupational identities further complicates the aggregation of interests and compromise-finding necessary for the functioning of joint self-administration.

scholarly journals Regional Differences in Prescribing Patterns of Metamizole in Germany Based on Data from 70 Million Persons

2020 ◽  
Vol 17 (11) ◽  
pp. 3892
Author(s):  
Falk Hoffmann ◽  
Carsten Bantel ◽  
Frederik Tilmann von Rosen ◽  
Kathrin Jobski
Keyword(s):  
Regional Differences ◽  
Statutory Health Insurance ◽  
Opioid Analgesic ◽  
Prescribing Patterns ◽  
Related Factors ◽  
Aggregated Data ◽  
Market Withdrawal ◽  
Total Prevalence ◽  
Insurance Funds ◽  
Health Insurance Funds

The non-opioid analgesic metamizole (dipyrone) is commonly used in Germany despite its narrow indications and market withdrawal from several countries. In this study we analyzed prescribing patterns of metamizole focusing on regional differences. The source of data was the “Information system for health care data” which includes data from the statutory health insurance funds for about 70 million Germans. We received aggregated data of individuals with at least one metamizole prescription in 2010 as well as the number of prescribed packages by age, sex, state and district along with the number of insured persons in each stratum. We calculated prescription prevalence stratified by age, sex, state and district. Among 68.4 million insured persons (mean age: 43.6 years; 53.0% female) 5.5 million received at least one metamizole prescription (8.1%, overall 12.2 million packages). Prevalence increased with age, and women received metamizole more often than men. In adults (total prevalence: 9.4%), levels varied between 7.0% (Saxony) and 11.1% (Schleswig-Holstein), whereas on a district level use ranged from 4.3% to 14.3%. In 2010, one of 12 individuals received metamizole at least once. Noticeable were the large regional variations which certainly cannot be explained by patient-related factors.

Back to the future: Polish health care reform

2003 ◽  
Vol 36 (4) ◽  
pp. 385-403 ◽  
Author(s):  
Rachel Filinson ◽  
Piotr Chmielewski ◽  
Darek Niklas
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Workers ◽  
Universal Health Insurance ◽  
Care Workers ◽  
Insurance Funds ◽  
Physician Resistance ◽  
Polish Government ◽  
Health Insurance Funds ◽  
Universal Health

In January 1999, the Polish government implemented a new law reorganizing the health care in the country. This paper includes an outline of the changes, the main impact of which consisted of introduction of universal health insurance administered by Health Insurance Funds (‘‘Kasy Chorych’’). In June 2001 and 2002, a survey of insurance administrators and health care workers provided data concerning the reception of the new system, the perceived inadequacies, and the postulated changes. The intended objective of privatization of health provisions appears as remote as it was before the changes. The major obstacles are identified as political hurdles, physician resistance, and continued dependence on state allocations.

scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

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