Health Services Research and Health Economy – Quality Care Training in Gynaecology, with Focus On Gynaecological Oncology

Abstract

In the era of cost increases and reduced resources in the German healthcare system, the value of health services research and health economics is increasing more and more. Health services research attempts to develop concepts for the most effective ways to organise, manage, finance and deliver high-quality care and evaluates the implementation of these concepts with regard to daily routine conditions. Goals are the assessment of benefits and the economic advantages and disadvantages of new and established diagnostic methods, drugs and vaccines. Regarding these goals, it is clear that health services research goes hand in hand with health economics, which evaluates the benefits of diagnostic and therapeutic procedures in relation to the costs. Both scientific fields have focus principally on gynaecology and particularly on gynaecological oncology in Germany, as can be seen by numerous publications. These present several advantages compared with clinical trials ? they uncover gaps in health care, question the material, staffing and consequently the financial resources required and they allow the estimation of value and the comparison of different innovations to identify the best options for our patients.

Can a University Reproductive Medicine Centre Be Financed Under the Pre-Existing General Conditions in Germany?

“…However, to achieve further advancements in the treatment of sterility and infertility, it is essential for research and science to offer corresponding treatments in a university setting. There must be a suitable infrastructure to derive hypotheses and, in the next step, implement them in practice 13 . Notably, the first IVF baby also came into existence in a university setting.…”

“…In the field of fertility protection as well, the preservation of university fertility centres is essential: the first successful ovarian transplantation following chemotherapy by the University of Erlangen OB/GYN clinic in 2008 and the first pregnancy following a successful ovarian transplantation through cooperation between the centres of the Bonn, Dresden and Erlangen university hospitals in 2011 demonstrate the importance of university centres in reproductive medicine 15 . Close collaboration between the various medical disciplines, especially oncology and reproductive medicine, is of great importance for the success of a treatment 13 , 16 . This infrastructure can largely only be offered at university centres.…”

“…In contrast to this is the decreasing number of endocrinology, reproductive medicine and andrology departments at the universities and the growing market share of private reproductive medicine practices in which up to 75% of artificial fertilisations are currently performed. At present, the cooperation between practices and university hospitals is not sufficient 13 . Clear concepts and networks would have to be created to ensure the successful continued existence of reproductive medicine in Germany 17 , 18 .…”

“…In addition, the infrastructure of the university centres must be adequately remunerated. This requires sufficient financing which should not be shifted to the patients or service providers 13 . Otherwise Germany can no longer compete internationally with other countries in the field of reproductive medicine in terms of science and also with regard to aspects of treatment quality.…”

“…Otherwise Germany can no longer compete internationally with other countries in the field of reproductive medicine in terms of science and also with regard to aspects of treatment quality. This development is fostered by both the relatively restrictive legal situation and on the other hand by the inadequate remuneration 13 .…”