Utilization of Medical Services in Germany—Outline of Statutory Health Insurance System (SHI)

Bormann, Cornelia; Swart, Enno

doi:10.1007/978-1-4614-9191-0_3

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…Administrative levels below state level neither have legislative implications for health care provision [ 14 ], nor do their boundaries pose limitations regarding health care utilisation [ 15 ]. Therefore, we apply the concept of patient sharing networks (PSN) in this study.…”

Section: Introductionmentioning

confidence: 99%

Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care

Domhoff

Seibert

Stiefler

et al. 2021

BMC Health Serv Res

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Background People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision. Methods We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators. Results The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive. Conclusions Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.

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Section: Introductionmentioning

confidence: 99%

Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care

Domhoff

Seibert

Stiefler

et al. 2021

BMC Health Serv Res

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“…Germany's SHI is organized according to the principle of solidarity with contributions adjusted to financial means, shared risk-pooling and tax-financed transfers to cover fees of the unemployed. Membership in the SHI is mandatory with only a few exceptions (for affluent persons, public officials and self-employed), and these groups have to prove any other health insurance coverage instead [2,3].…”

Section: Introductionmentioning

confidence: 99%

Differences in realized access to healthcare among newly arrived refugees in Germany: results from a natural quasi-experiment

et al. 2020

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Background: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. Methods: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasiexperiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. Results: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. Conclusion: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.

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“…This may be due partly to the higher prevalence of the mental disorders treated in this setting (anxiety; depression; eating disorders; somatoform and dissociative disorders) in women Wittchen 2011;Meyer 2000). Also women are more willing to seek help and access medical (Bergmann & Kamtsiuris 1999) and mental health services . This is probably due to different role expectations and gender stereotypes for men and women, making it more socially and personally acceptable for women to have a mental health problem and to seek professional help for it (Möller-Leimkühler 2000).…”

Section: Discussionmentioning

confidence: 99%

Operationalized Psychodynamic Diagnosis System and Outcome of Psychodynamic Inpatient Psychotherapy in Male and Female Patients

Schneider

Heuft

2018

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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Objective: To compare male and female patients with regard to the Operationalized Psychodynamic Diagnosis (OPD-2) system, treatment variables, and outcome after multimodal psychodynamic inpatient psychotherapy. Methods: At the beginning and at the end of inpatient treatment in a multimodal psychodynamic setting, patients were examined with the OPD-2 system as well as with three self-assessment questionnaires addressing interpersonal problems (Inventory of Interpersonal Problems, IIP), and psychopathology: Brief Symptom Inventory (BSI) and the Hospital Anxiety and Depression Scale (HADS). Results: Data of 850 patients (238 males, 28%), 612 females, 72%) were available for analysis. There were differences between men and women in the main diagnoses, with a higher proportion of eating disorders and a longer treatment duration among the women. Therapy discontinuation rates were low and did not differ between the sexes. Women scored higher on psychopathology at admission on the BSI Global Score, IIP and anxiety; the pattern of reported interpersonal problems was consistent with sex roles. While the level of structural integration was similar in both sexes, the distribution of the two main conflicts and the level of improvement of awareness and dealing with the psychodynamic foci showed significant differences. Overall, at the end of inpatient psychotherapy, there was a mean improvement in both men and women, with no significant differences between them. Because of higher scores at the start of psychotherapy, the effect sizes for improvement were higher for women. Conclusions: On the whole, both sexes seem to benefit equally from psychodynamic inpatient psychotherapy in terms of symptom improvement.

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Utilization of Medical Services in Germany—Outline of Statutory Health Insurance System (SHI)

Cited by 6 publications

References 4 publications

Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care

Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care

Differences in realized access to healthcare among newly arrived refugees in Germany: results from a natural quasi-experiment

Operationalized Psychodynamic Diagnosis System and Outcome of Psychodynamic Inpatient Psychotherapy in Male and Female Patients

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