Strategisches Controlling zur Berücksichtigung des soziodemographischen Wandels in einem sozialmedizinischen Dienst

Abstract

Annually the Medizinische Dienst der Krankenversicherung Westfalen-Lippe (MDK-WL) performs approximately 120,000 nursing care assessments according to the 11th social statute book (SGB XI). A prospective reflection on the amount of expert assessments and the spectrum of services for the Nursing Care Insurance until 2020, was performed in order to establish a long term strategic controlling. The insured party makes the request for nursing care according to their personal estimation when the need for assistance is increasing. To predict the future amount of expert assessments you have to take into consideration the social background of the families in addition to age and gender (there is a clear correlation between age and the need of assistance). The database from nursing care assessments in 2001 was projected on a demographic model for the region of Westfalen-Lippe. The amount of requests correlates as expected with the patients age and increases exponentially. The incidence in the need of care shows relevant gender differences, but taken into consideration the very different age structure, the overall incidence is very similar. Against the background of the current nursing care law, the MDK-WL has to deal with an annual increase in assessments of 2 %. The requests for single persons are extremely often without foundation (55 % not substantially in need of care vs. 35 %). Looking at the requests of couples, it shows that the ones for women are more often unfounded then the ones for men (39 % vs. 32 %). It is necessary to take the development of the amount of single living persons into consideration to achieve more accurate predictions for the amount of assessments.