Status quo und gesundheitspolitischer Reformbedarf im ambulanten Vergütungssystem

Herr, David W.; Messerle, Robert; Schreyögg, Jonas

doi:10.5771/1611-5821-2018-4-5-8

Cited by 4 publications

(4 citation statements)

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“… 32 These could be direct, for example, monetary compensation for prescription and progress checks, or indirect, for example, reduced visit frequencies of patients that do not result in additional compensation due to reimbursement rules. 42 …”

Section: Discussionmentioning

confidence: 99%

There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany

et al. 2022

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Background Mobile health applications and their subset digital therapeutics—defined as evidence-based software interventions to prevent, manage, or treat a medical condition—offer great potential to improve patient care. However, such solutions often struggle to reach widespread adoption. Objective This study seeks to explore healthcare stakeholders’ roles and potential for fostering patient access and adherence to evidence-based digital therapeutics and thereby improve health outcomes from the perspective of digital therapeutics developers and distributors. Methods Semi-structured qualitative and semiquantitative interviews were conducted with 19 experts from developers and distributors of digital therapeutics in Germany to discuss their perceived relevance of different healthcare stakeholders and strategies in promoting patient access and adherence to digital therapeutics. Results Healthcare professionals were found to have the greatest potential to promote both access and patient adherence to digital therapeutics, followed by health insurers, pharmaceutical companies, and patients themselves. In terms of patient access, healthcare professionals have potential due to their ability to prescribe digital therapeutics. Other stakeholders’ potential stems from their capacity to influence healthcare professionals prescription decision. In terms of patient adherence, only healthcare professionals are of high relevance by onboarding patients and monitoring digital therapeutics use. Most healthcare stakeholders currently do not fully leverage their potential. Further educating healthcare professionals and simplifying processes for them, empowering patients to seek treatment with digital therapeutics, and designing digital therapeutics’ product features for better adherence can help improve patient access and adherence. Conclusions Established healthcare stakeholders and digital therapeutics developers both need to take action to improve patient access and adherence to digital therapeutics. Several macro-level changes can support these efforts, including broader information dissemination, improved financial incentives, simplified prescription and activation processes, and a wider adoption of blended care and pay-for-performance payment models.

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Section: Discussionmentioning

confidence: 99%

There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany

et al. 2022

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“…Aus Sicht der Kliniken sind diese Vergütungen nicht kostendeckend (Haas et al 2015). Diskutiert wird daher, dass hieraus Anreize zur Generierung unnötiger stationärer Fälle entstehen (Herr et al 2018) Bei den Fallbeispielen handelt es sich um Krankheitsbilder und/oder Behandlungsverfahren, die prinzipiell sowohl stationär als auch ambulant medizinisch versorgt werden können. Sie sollen exemplarisch veranschaulichen, wie groß die Vergütungs-bzw.…”

Section: Fazitunclassified

“…Eine weitere Gestaltungsoption besteht darin, sich einem mittleren Vergütungsniveau schrittweise über einen längeren Zeitraum zu nähern. So könnte sich eine Mischvergütung zunächst eher am höheren DRG-Preisniveau orientieren, damit auch Krankenhäuser ambulante Leistungen kostendeckend anbieten können und nicht zu starke Anreize haben, stationäre Fälle zu generieren (Herr et al 2018). Das Preisniveau könnte dann im Zeitverlauf abge-senkt werden.…”

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“…Die zentrale Frage hierbei ist, welches Behandlungssetting unter Effizienzgesichtspunkten die Referenz für eine solche Kostenerhebung sein soll. Während sich die Preisniveauentwicklung in der Krankenhausvergütung derzeit an der durchschnittlichen jährlichen Veränderung der Krankenhauskosten orientiert und damit die vorhandenen Strukturen abbildet, 14 orientiert sich die Preisniveauentwicklung in der vertragsärztlichen Vergütung stärker normativ an den Kosten einer Einzelpraxis mit durchschnittlicher Leistungs-und Kostenstruktur (Herr et al 2018). Die Forderung nach Kalkulationspraxen (Bock et al 2017) für die Kalkulation sektorenunabhängiger Fallpauschalen bleibt daher unklar.…”

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