ᅟWe analyze one-year costs and savings of a telemedically supported case management program after kidney transplantation from the perspective of the German Healthcare System. Recipients of living donor kidney transplantation (N = 46) were randomly allocated to either (1) standard aftercare or (2) standard aftercare plus additional telemedically supported case management. A range of cost figures of each patient’s medical service utilization were calculated at month 3, 6 and 12 and analyzed using two-part regression models.In comparison to standard aftercare, patients receiving telemedically supported case management are associated with substantial lower costs related to unscheduled hospitalizations (mean difference: €3,417.46 per patient for the entire one-year period, p = 0.003). Taking all cost figures into account, patients receiving standard aftercare are associated, on average, with one-year medical service utilization costs of €10,449.28, while patients receiving telemedically supported case management are associated with €5,504.21 of costs (mean difference: € 4,945.07 per patient, p < 0.001). With estimated expenditures of €3,001.5 for telemedically supported case management of a single patient, we determined a mean difference of €1,943.57, but this result is not statistically significant (p = 0.128). Sensitivity analyses show that the program becomes cost-neutral at around ten participating patients, and was beneficial starting at 15 patients. Routine implementation of telemedically supported case management in German medium and high-volume transplant centers would result in annual cost savings of €791,033 for the German healthcare system.Patients with telemedically supported case management showed a lower utilization of medical services as well as better medical outcomes. Therefore, such programs should be implemented in medium and high-volume transplant centers.Trial registrationDRKS00007634 (http://www.drks.de/DRKS00007634).

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Due to the debate about the generosity of LTC insurance benefits the German government decided to increase benefits and widen the circle of LTC beneficiaries with the Second LTC Strengthening Act. In this paper, we evaluate the long-term implications of this recent reform for the German LTC insurance scheme. Using the framework of generational accounting we show that the reform has led to a widening of the short-term gap between revenues and expenditure and that the LTC insurance is not sustainably financed, neither pre-nor post-reform. By the early 2020s there will be fiscal pressure for further reforms. From an intergenerational perspective, the reform can be seen as a windfall to current beneficiaries increasing the intergenerational redistribution through the pay-as-you-go system. We would like to thank BARMER health insurance for generously providing us with the necessary data to conduct our research. Our study has been conducted independently and all conclusion drawn and opinions stated are solely our own. In addition, we would like to thank Jasmin Kersting for proofreading and helpful comments. All remaining errors are our own.

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:  Using a generational accounting approach, we analyse the sustainability of the German Statutory Social Health Insurance. Due to the future double aging process, the current level of health benefits can only be maintained through a massive increase in the contribution rate. Additionally taking into account the medical‐technical progress would severely worsen the long‐term stance of the German Health Insurance Scheme. To restore a sustainable situation, we suggest a reform proposal, the so called “Freiburger Agenda”. This reform contains a minimum franchise, the privatisation of the entire dental care as well as the introduction of more market forces thus intensifying competition between e.g. hospitals and insurance companies.

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Background In view of the upcoming demographic transition, there is still no clear evidence on how increasing life expectancy will affect future disease burden, especially regarding specific diseases. In our study, we project the future development of Germany’s ten most common non-infectious diseases (arthrosis, coronary heart disease, pulmonary, bronchial and tracheal cancer, chronic obstructive pulmonary disease, cerebrovascular diseases, dementia, depression, diabetes, dorsal pain and heart failure) in a Markov illness-death model with recovery until 2060. Methods The disease-specific input data stem from a consistent data set of a major sickness fund covering about four million people, the demographic components from official population statistics. Using six different scenarios concerning an expansion and a compression of morbidity as well as increasing recovery and effective prevention, we can show the possible future range of disease burden and, by disentangling the effects, reveal the significant differences between the various diseases in interaction with the demographic components. Results Our results indicate that, although strongly age-related diseases like dementia or heart failure show the highest relative increase rates, diseases of the musculoskeletal system, such as dorsal pain and arthrosis, still will be responsible for the majority of the German population’s future disease burden in 2060, with about 25–27 and 13–15 million patients, respectively. Most importantly, for almost all considered diseases a significant increase in burden of disease can be expected even in case of a compression of morbidity. Conclusion A massive case-load is emerging on the German health care system, which can only be alleviated by more effective prevention. Immediate action by policy makers and health care managers is needed, as otherwise the prevalence of widespread diseases will become unsustainable from a capacity point-of-view.