Gemeinsamer Bundesausschuss Research Articles

Beispiele für Screeninguntersuchungen

Primary prevention of cancer still only finds limited acceptance in the general population, therefore, secondary prevention plays an important role in order to avoid the high costs necessary for the treatment of advanced forms of cancer. Breast cancer, prostate cancer and colorectal carcinoma (CRC) are the most common forms of cancer with high mortality and a high socio-economic impact. Screening tests for these diseases are effective and simple to carry out. The measures for secondary prevention are well known but are only implemented to approximately 30-40%. For persons over 55 years old routine screening at 10-year intervals by ileocoloscopy is now established for CRC, or alternatively an annual examination for occult blood in faeces (FOBT) over 50 years of age. Screening mammography for women aged between 50 and 69 years old is firmly established in the guidelines of the Gemeinsamer Bundesausschuss since 2004 for early recognition of cancer. It is anticipated that the establishment of the screening programme in Germany will be completed in all Federal States by the end of March 2008. All men over 45 years of age who are compulsory insured are entitled to have an annual examination of the external genital organs and a digital rectal examination of the prostate under the compulsory cancer early recognition programme. PSA testing within the framework of preventive examinations is, however, not yet part of the catalogue of available tests.

Einschränkungen der Handlungs- und Therapiefreiheit der Ärzte und der gesundheitlichen Versorgung der Bevölkerung durch Verknappung der wirtschaftlichen und personellen Mittel – Was sind die Gebote der § 2 Abs. 1 und 4 Musterberufsordnung noch Wert?

Up to the early 1990's the health care system was essentially characterised through:--the insured' right of choice of therapist,--therapeutic freedom of patients and physicians, and--the freedom of establishment for medical doctors.--In accordance with the Hospital Funding Act the hospital system was--in compliance with federal constitutional law using capacity requirements--based on the "fire-fighting" principle, i.e. that if required, every patient should have access to a suitable hospital bed within about 15 minutes.--The responsibility for ensuring the provision of general and specialist health care services had been conferred by the government to the National Association of Statutory Health Insurance Physicians (1955) in the legal form of a public corporation. In the face of a foreseeable rise in expenses as a result of advances in medicine and a higher demand for health care services because of the demographic development (long-life society) the Advisory Council for Concerted Action in Health Care concludes in its Annual Report that maintaining this level of health care for all people is not financially viable any longer. This is why the state--on the basis of the Health Care Reform Act of 2002 and the Statutory Health Insurance System Modernisation Act of 2004--retreated from the provision of services in the ambulatory and inpatient setting by privatising these sectors and by proclaiming competition (introduction of diagnosis-related groups). Presently, the once liberal performance tradition is more and more turning into a centrally planned system in the spirit of "From Therapeutic Freedom to Therapeutic Programmes". The guidelines that on the basis of the methods of evidence-based medicine were developed by the international community of physicians for the treatment of patients with defined diagnoses and intended to be decision aids for individual treatment decisions are now used to implement disease management programmes for the provision of health care to people with certain chronic diseases. Another steering instrument of the above mentioned Modernisation Act is the definition of a list stating all the benefits available under the statutory health insurance system. The assessment of the health gain of new medical drugs and other medical procedures has been assigned to the Institute for Quality and Efficiency in Health Care (IQWiG) specifically founded to that purpose. With regard to the assessment of diagnostic and therapeutic procedures the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) in the summer of 2005 gave itself a Code of Procedures that defines uniform cross-sector criteria for the appraisal of diagnosis and treatment. In Germany the principle of evidence-based health care has by law--and this is unique as compared to other countries--fully penetrated everyday health care where the decisions of the Joint Federal Committee in the form of directives have mandatory effect for health care providers and hence for the insured, too. This is why the German Medical Association and the National Association of Statutory Health Insurance Physicians have embarked on the implementation of the "National Programme for Disease Management Guidelines" and the "Health Services Research" Project as a means of continuously evaluating health care provision which are intended to guide the future political control of the system of statutory health insurance in terms of target-performance comparisons and for the purpose of identifying health care deficits.

Clinical performance measurement in surgery and orthopedics -- new aspects in 2004

In 2004, principles and practice of clinical performance measurement (CPM) in German hospitals were changed according to new legislative and administrative regulations. In many respects, focus and methods of clinical performance measurement were improved in favour of hospitals. Starting from January 1, 2004, the new Gemeinsamer Bundesausschuss (Joint Federal Board) has competence for decisions on future focus and scope of CPM. Former agreements on implementation of CPM in 2004 will be effective as long as Gemeinsamer Bundesausschuss passes new resolutions. Methods to identify relevant cases for CPM particularly changed in 2004. Until end of 2003, obligations to report case data were based on special types of hospital reimbursement. In 2004, obligations for reporting no longer derive from financial criteria, but from medical criteria such as diagnoses and procedures. In 2003, reporting for CPM covered more than 30 subjects in medicine and nursing. For 2004, the scope of CPM has been reduced by 13 subjects which need to be reconsidered in order to secure unified quality goals for out-patients as well as in-patients and to allow long-term follow-up of outcome data. For their CPM expenditure, hospitals receive an additional fee of euro 0.58 per case reimbursed by DRG. Financial sanctions will be effective for hospitals with overall CPM reporting rates below 80 %. Starting from 2005, hospitals are obliged to publish CPM reporting rates for each CPM subject in annual hospital quality reports.