Priorisierung im Deutschen Gesundheitswesen – Ein Thema in der Augenheilkunde?

Abstract

At the 111th German Medical Assembly in May 2008 in Ulm, Germany, a public debate on rationing of health care performances was started. Since the money in the German health care system is not enough to provide every diagnostic or therapy for every patient as a coverage of the compulsory medical insurances, a lot of specific health care performances have been rationed during the last years not to be covered by the regular medical insurance any more, such as, e. g., PSA measurements in urology or IOP measurements in ophthalmology. In contrast to the health care system in Scandinavia, where rationing of health care performances is publicly documented by the government, no similar public statements exist in Germany. Due to this, it is left to physicians to explain to their patients the "hidden" rationing of public health care performances, which also leads to an increase in individual health care performances (IGeL in Germany) to be paid for privately by the patient. It is undoubtedly true that not all medically possible performances need to be paid for by the health insurance; however, an official determination of these "out of pocket" health care performances is necessary. Therefore, it was the aim herein to work out possible "stop" criteria--according to the Scandinavian system--for common eye diseases and consecutive therapies, which need not be paid for or only be paid after a delay by the health insurances.

Intravitreal treatment in patients with exudative age-related macular degeneration and visual acuity ≤ 0.05

“…Standard treatment of exudative ARMD is repeat intravitreal injection of anti-vascular endothelial growth factor (VEGF) antibody, ranibizumab, aflibercept, or pegabtanib, which are legally accepted but expensive. Because of increased age of the general population, insurance companies are increasingly less likely to pay for treatment for all patients [ 2 ]. Therefore, a few years ago, insurance companies requested a minimal best corrected visual acuity of ≥ 0.05 to financially cover ARMD treatment with photodynamic therapy in Germany.…”