Zusammenfassung AbstractThe present cost-of-illness study is focused on the costs of COPD in Germany. In a pre-study, data on 814 randomly selected patients were collected to achieve reliable figures for the distribution of COPD severity grades and the frequencies of exacerbations. The main study was performed on 321 randomly selected patients from the pre-study. Data on resource use were collected in a face-to-face interview with the respective physicians using the patient records as a basis. Costs associated with resource consumption were weighted with the frequencies of COPD severity grades as assessed in the pre-study to determine the costs of COPD. Annual COPD-related costs per patient were € 3,027 from the societal perspective. Main cost components were hospitalisations (26 %), medication (23 %) and early retirement (17 %). Annual COPD-related costs from the perspective of the German health insurance system (GKV) were € 1,944 per patient.
As is the case in other areas of social security services, the German system of statutory health insurance has been battling aggravated financing problems since the mid-1990s. Public discussion in systems similar to Germany that are financed by contributions is mainly typified by the concepts of cost explosion and stability of premium rates. The German healthcare system faces the problem of finding an appropriate control strategy that makes it possible on the one hand to master the exogenous challenges posed by demography, especially advances in medical technology, and on the other hand to ensure that the chances inherent in the "growing market of health services" are not unduly regulated. Against the background of ongoing unemployment, it cannot be considered a long-term solution to continue in regulating a potential employment market with cost-cutting measures or even to favor a healthcare system financed by taxes.
The German discussion on the necessity and form of quality assurance in health care was promoted through legal changes. The objective of quality assurance is to control to assure and to improve quality in health care. For this reason a desired level of quality has to be determined and compared with the actually achieved level. If a deviation of quality is observed, actions for quality improvement are instituted. There are some problems in this context since the level of quality is a result of a patient's individual perception it is very difficult to set a common level. Furthermore the theoretical value of an analysis of deviations is restricted in those areas of health care, in which the relevant data are deeply distorted by statistical outliers caused by a heterogeneous structure of patients and a small number of cases. Therefore, quality assurance is only possible in such areas of medical care, in which numerous identical and non-complex services are provided to patients with a similar morbidity structure.
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