Evaluating geriatric rehabilitation from the perspective of medical service of the national health insurance administration

Abstract

There is evidence for the community effectiveness of preventive geriatric intervention programs prior to the need for help or long-term care from a couple of prospective randomized controlled trials (RCTs). For geriatric rehabilitation programs tailored to older people with imminent or manifest need for long-term care analogous--evidence is still lacking. The nationwide leading boards of the FRG's Sickness Insurance Administration in conjunction with its Central Medical Service have formulated guidelines for the formation of a nationwide ambulatory geriatric rehabilitation service to realize the postulate of the long-term care insurance legislation "rehabilitation prior to long-term care". These guidelines must be proven empirically. To prove the effectiveness and efficiency of the foreseen ambulatory geriatric rehabilitation service, the RCT design would be highly desirable. Unfortunately, the prerequisites in the field of methodology are poor since valid, reproducible and feasible criteria for the selection of suitable patients and measurement criteria which meet the requirement of proven medium-term sensitivity to change do not yet exist. Nevertheless, there is a great and urgent need, for the first time, to investigate the cost-effectiveness ratio for this ambulatory geriatric rehabilitation service to be established in the FRG, leaving aside the methodologic desiderata of randomized control-groups.