Challenges for the German Health Care System – Pharmaceuticals

Abstract

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.

How to perform Contrast-Enhanced Ultrasound (CEUS)

“…In Europe, CEUS in children is mostly “off-label” use, except for a few indications including vesico-ureteral reflux 64 . The same is true for many drugs, which are used off-label in paediatric practice and the question of “off label use” has been widely discussed 65 66 . The recent approval of SonoVue™/Lumason™ for use in paediatrics in the United States is a welcome first step towards the acceptance of this technique in the non-ionising imaging of children 67 .…”

Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients

“…IF may also require costly, potentially uncomfortable and sometimes invasive procedures to achieve a confident diagnosis, and can result in long-term follow-up. Further investigating an incidental finding should be organized in such a way that no pathology is missed, characterization is precise, but also the cost is kept to a balanced minimum, which is a general challenge for healthcare systems [ 9 , 236 , 237 , 238 ]. CEUS allows faster diagnosis compared to CECT and CEMRI and, therefore, is time saving [ 239 ].…”

Ultrasound Elastography for Characterization of Focal Liver Lesions

“…Except TE, all other SWE methods are integrated in conventional ultrasound systems and can be simultaneously used for the standard ultrasound examination of the liver to determinate the stiffness of the lesion, as well as of the surrounding liver parenchyma. All the mentioned ultrasound techniques allow prompt "one-stop shopping" of liver imaging, avoiding further investigations [24,25,26].…”