The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.
The analysis of a randomised 25%-sample shows that the target specifications of the DGE are only implemented by a small number of schools in the exemplary selected district of St. Wendel, Germany. As the German Child and Youth Health Survey (KiGGS), also this evaluation shows that the quality of school meals deviates significantly from the recommendations of the DGE. There is a clear need for action.
We recently addressed the challenges of the German Health Care System (GHCS) in an era of an aging population and economic problems discussing the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improvement measures. Pharmaceutical issues have not been mentioned in detail. It is of interest that increases in Social Health Insurance (SHI) expenditures on pharmaceuticals in Germany were above the European average in the last decades. There are three main aspects to consider when it comes to discussing the topic of pharmaceuticals in health care services, the efficacy of the drugs, safety issues and cost containment. The paper summarizes pharmaceutical issues as challenges for the German Health Care System.
Background: Adjuvant treatment of stage III colon cancer represents a significant economic burden for the German health care system. The available chemotherapy regimens have significantly different medical and economic profiles. Methods: A modeling study based on published clinical trials was performed to assess costs of 5 different regimens (Mayo Clinic, LV5FU2, FOLFOX-4, Xelox, Capecitabine) from the perspective of the statutory sickness funds. Costs were calculated based on the assumption that patients were treated exactly according to a standardized clinical pathway. Results: Total costs are highest for FOLFOX-4 (H22,034/patient) and Xelox (H21,411). Lowest costs of the oxaliplatin-free treatments are associated with capecitabine (H4,935), followed by the Mayo Clinic (H6,426) and LV5FU2 protocols (H8,336). The main driver of costs in all instances is drug acquisition (90% of total costs), whereas costs of diagnostics or complications have no major impact (0.5–2%). Conclusions: In Germany, FOLFOX-4 is the most effective but also the most expensive treatment and represents the current standard. Xelox emerges as a slightly less costly alternative when oral treatment is preferred. For patients not able to tolerate oxaliplatin-based therapy, capecitabine has the best economic profile of all alternative regimens. Drug acquisition costs are by far the most important factor driving costs in all regimens.
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