Transformation des deutschen Gesundheitssystems Anforderungen und Instrumente

2005 ◽  
Vol 54 (1) ◽  
Author(s):  
Torsten Sundmacher

AbstractA rising discussion can be seen concerning a transformation of health care systems. Real system changes have till now strengthened competition predominantly and reduced state interventions. Such a procedure also is probably the right way for the German system. Previous reform trials in Germany have i.e. introduced the Integrated Health Care (Integrierte Versorgung, IV). In this special health care form, single contractual regulations are allowed in the contract relationship between doctors and health insurance companies. These contracts partly take the usual collective agreements off. But, until now, the significance of this special form for the normal health care is minor, though. Whether the IV can be a starting point to a system transformation of the health care system by small steps is the question to be examined here.

2017 ◽  
Vol 36 (4) ◽  
pp. 33-67 ◽  
Author(s):  
Nick Kates

For 20 years mental health and primary care providers across Canada have been working collaboratively together to improve access to care, provider skills, and patient experience. The new strategic plan of the Mental Health Commission of Canada (MHCC) offers many opportunities for collaborative care to play a role in the transformation of Canada’s mental health systems. To assist the plan, this paper presents principles underlying successful projects and ways that mental health and primary care services can work together more collaboratively, including integrating mental health providers in primary care. It integrates these concepts into a Canadian Model for Collaborative Mental Health Care that can guide future expansion of these approaches, and suggests ways in which better collaboration can address wider issues facing all of Canada’s health care systems.


Author(s):  
Patricia Illingworth ◽  
Wendy E. Parmet

Immigration and health are two of the most contentious issues facing policy makers today. Policies that relate to both issues—to the health of newcomers—often reflect misimpressions about immigrants, their health, and their impact on health care systems. Although immigrants are typically younger and healthier than natives, and many newcomers play a vital role in providing care in their new lands, natives are often reluctant to extend basic health care to immigrants. Likewise, many nations turn against immigrants when epidemics strike, falsely believing that native populations can be kept well by keeping immigrants out. This book demonstrates how such reactions thwart attempts to create efficient and effective health policies and efforts to promote public health. The book argues that because health is a global public good and people benefit from the health of neighbor and stranger alike, it is in everyone’s interest to ensure the health of all. Reviewing issues as diverse as medical repatriation, epidemic controls, the right to health, the medical brain drain, organ tourism, and global climate change, the book shows why solidarity between natives and newcomers is ethically required and in the service of health for all.


2021 ◽  
pp. 220-241
Author(s):  
Carlos Lema Añón

The COVID-19 pandemic has particularly affected Spain in 2020. Although the specific causes and Spain’s response—as well as the aspects to be improved—are yet to be evaluated, many experts agree that this crisis has magnified some of the problems of the Spanish health system, highlighting the problems derived from the cuts in the capacities of the health and public health systems. We assess the current situation from the perspective of the right to health in its twofold dimension: health care and social determinants. For this purpose, we look into the configuration of the right to health in Spain and how the economic crisis and austerity policies affected it. In particular, we consider the impact both on institutional health care systems and in terms of social determinants of health. Finally, we make several proposals for strengthening the right to health.


Author(s):  
Alex Rajczi

One cannot discuss the ethics of health policy without understanding how health systems work, so this chapter provides background on the American health system before and after the Affordable Care Act. It also describes two universal health insurance systems the U.S. could adopt. In Canada’s single-payer system, the government serves as the basic insurer for the entire population. In the regulated-market systems of Switzerland and the Netherlands, citizens must purchase health insurance through private companies, and the government’s main jobs are providing subsidies to less wealthy individuals and ensuring that insurance companies deal fairly with citizens. The chapter concludes by examining the core ideas behind consumer-driven health care, a set of specific policies that conservatives often add to their health care proposals.


1996 ◽  
Vol 26 (4) ◽  
pp. 777-802 ◽  
Author(s):  
Hans-Ulrich Deppe ◽  
Stjepan Oreskovic

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the “Bismarck model” in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions; these preconditions are not present in the FSEs.


2019 ◽  
Vol 12 (2) ◽  
pp. 133-144 ◽  
Author(s):  
Ben Davies ◽  
Julian Savulescu

Abstract Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health.


2019 ◽  
Vol 37 (34) ◽  
pp. 3203-3211 ◽  
Author(s):  
Reshma Jagsi ◽  
Kent A. Griffith ◽  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Michele Gornick ◽  
...  

PURPOSE We sought to generate informed and considered opinions regarding acceptable secondary uses of deidentified health information and consent models for oncology learning health care systems. METHODS Day-long democratic deliberation sessions included 217 patients with cancer at four geographically and sociodemographically diverse sites. Patients completed three surveys (at baseline, immediately after deliberation, and 1-month follow-up). RESULTS Participants were 67.3% female, 21.7% black, and 6.0% Hispanic. The most notable changes in perceptions after deliberation related to use of deidentified medical-record data by insurance companies. After discussion, 72.3% of participants felt comfortable if the purpose was to make sure patients receive recommended care ( v 79.5% at baseline; P = .03); 24.9% felt comfortable if the purpose was to determine eligibility for coverage or reimbursement ( v 50.9% at baseline; P < .001). The most notable change about secondary research use related to believing it was important that doctors ask patients at least once whether researchers can use deidentified medical-records data for future research. The proportion endorsing high importance decreased from baseline (82.2%) to 68.7% immediately after discussion ( P < .001), and remained decreased at 73.1% ( P = .01) at follow-up. At follow-up, non-Hispanic whites were more likely to consider it highly important to be able to conduct medical research with deidentified electronic health records (96.8% v 87.7%; P = .01) and less likely to consider it highly important for doctors to get a patient’s permission each time deidentified medical record information is used for research (23.2% v 51.6%; P < .001). CONCLUSION This research confirms that most patients wish to be asked before deidentified medical records are used for research. Policies designed to realize the potential benefits of learning health care systems can, and should be, grounded in informed and considered public opinion.


Author(s):  
Patricia Illingworth ◽  
Wendy E. Parmet

Many nations claim to respect the right to health, which requires states to provide access to necessary health care without discrimination of any kind. Nevertheless, most states that purport to recognize the right to health discriminate against some classes of newcomers, especially unauthorized immigrants. This chapter reviews the status of immigrants’ right to health under international law and then turns to an examination of immigrants’ access to health insurance in Canada and the European Union. The chapter demonstrates that even in nations that are widely believed to have universal health care systems, many classes of immigrants are left without access to the means to pay for needed health care. As in the United States, these exclusions impact the health of newcomers and natives alike.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9502-9502
Author(s):  
P. Neumann ◽  
S. R. Berry ◽  
E. Nadler ◽  
W. C. Evans ◽  
J. Palmer ◽  
...  

9502 Background: Drug costs and reimbursement issues offer significant challenges to U.S. and Canadian oncologists even though they practice in substantially different health care systems. However, little is known about the attitudes of American and Canadian oncologists towards these issues. Methods: We surveyed 1,379 U.S. and 356 Cdn oncologists to assess their attitudes to cancer drug costs, CE and reimbursement policies. Results: Response rate was 57% in the U.S. and 48% in Canada. Oncologists in both countries stated that patients' “out-of-pocket” drug costs influenced their treatment recommendations (84% U.S., 80% Cdn respondents). Most respondents felt that every patient should have access to effective cancer treatments regardless of cost (66% US; 54% Cdn), while 59% of U.S. and 72% of Cdn and respondents believed that patients should only have access to effective cancer treatments that provided “good value for money.” 70% of U.S. and 64% Cdn respondents felt that <$100,000 per life year gained was a reasonable definition of “good value for money” but less than half of respondents (42% US, 49% Cdn) felt well prepared to interpret and use CE information in their treatment decisions. A majority of respondents (57% US, 69% Cdn) felt government price controls for cancer drugs are needed while a minority felt that more cost-sharing by patients was needed (29% US, 37% Cdn). Most oncologists felt that evaluating whether a drug provides “good value” should be overseen by an independent non-profit agency (57% US, 71% Cdn) or physicians (61% US and Cdn); in contrast, few believed that government (21% US, 33% Cdn), patients (36% US, 37% Cdn) or insurance companies (6% US, 10% Cdn) should determine “good value”. 79% of U.S. and 69% of Cdn respondents felt more use of CE data in coverage and reimbursement decisions is needed. Conclusions: Oncologists in the U.S. and Canada share many similar attitudes to cancer drug costs, CE, and reimbursement policies despite differences in their health care systems. In both countries, oncologists favor more use of CE information. No significant financial relationships to disclose.


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