Zufriedenheit mit der Gesundheitsversorgung: Gibt es strukturelle Unterschiede?

2018 ◽  
Vol 67 (3) ◽  
pp. 288-307
Author(s):  
Katharina Lima de Miranda ◽  
Daniel Prosi ◽  
Ulrich Schmidt ◽  
Hanna Wecker
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
Waiting Times ◽  
Private Insurance ◽  
Public And Private ◽  
Structural Differences ◽  
Urban And Rural Areas ◽  
Care Costs

Abstract This study examines structural differences in the subjective quality of health care in Germany using a newspaper survey. We find that there are significant differences between urban and rural areas as well as between public and private insurance. In rural areas, the provision of general practitioners, specialists and hospitals are considered as worse than in cities. In particular, public insured individuals asses the provision of specialized doctors and hospitals as lower than private insured and criticize long waiting times for appointments and lacking coverage of health care costs by the statutory health insurance.

scholarly journals Health Care Costs: On the Rise Again

2003 ◽  
Vol 17 (2) ◽  
pp. 125-148 ◽  
Author(s):  
Sherry Glied
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
New Technologies ◽  
Private Insurance ◽  
National Income ◽  
Insurance Market ◽  
The Face ◽  
Private And Public ◽  
Care Costs

Since 1999, health care costs have been growing faster than national income. This rapid growth has occurred as the ability of private and public purchasers to reduce service utilization and bargain for lower prices has fallen, insurers have recouped lost profits through higher premiums, and new technologies have driven up costs throughout the sector. Private insurance market responses to these rising costs may lead to reductions in the number of people with insurance and to increased fragmentation of the insurance market. Over time, technological change in medicine both increases costs and improves the quality of care. The challenge for public policy is to maintain insurance and some degree of equity in the face of these rising costs.

scholarly journals Making Emergency Care in Rural Areas Fit for Future: Protocol for multi-method and multi-perspective longitudinal analysis and control group study (Preprint)

2019 ◽  
Author(s):  
Camilla Metelmann ◽  
Bibiana Metelmann ◽  
Dorothea Kohnen ◽  
Clara Prasser ◽  
Rebekka Süss ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
First Aid ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Free Interval ◽  
Emergency Medical

BACKGROUND The German Emergency Medical Services is a two-tiered system with paramedic staffed ambulances as primary response supported by pre-hospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply whilst the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of essence [1], because with each minute passing, the chance of survival with good neurological outcome decreases. OBJECTIVE The project follows four main objectives: 1) Reducing the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (called bystander-CPR), (2) fast, professional first aid in addition to rescue services through alarming trained first aiders via smartphone, (3) faster and higher availability of emergency physicians through introducing the tele-emergency physician (TEP) system, and (4) enhanced emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS The implementation of the project is evaluated through a tripartite prospective and intervention study: (1) in medical evaluation, the influences of various project measures on quality of care are assessed using multiple methods. (2) The economic evaluation mainly focuses on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. (3) As part of the scientific work and organizational evaluation important work- and occupational-related parameters but also network and regional indexes are assessed. RESULTS The project was started in 2017 and enrollment will be completed in 2020. The pre-analysis phase recently finished. CONCLUSIONS Overall, the implementation of the project entails the realignment of emergency medicine in rural areas and the enhancement of quality of medical emergency care in the long-term. It is expected to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills as well as much more frequently provided first aid through medical laypersons. Furthermore, the project is intended to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via smartphones. As demonstrated by previous projects in urban regions, the TEP system has already proven a higher availability and quality of emergency call-outs in regular health care. A closer interrelation of emergency practices of statutory health insurance physicians with the rescue service is expected to lead to a better coordination of rescue and on-call services. CLINICALTRIAL Ethikkomission (ethics comission) an der Universität Greifswald BB 111/17 http://www2.medizin.uni-greifswald.de/ethik/

scholarly journals Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis

10.2196/14358 ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. e14358 ◽  
Author(s):  
Camilla Metelmann ◽  
Bibiana Metelmann ◽  
Dorothea Kohnen ◽  
Clara Prasser ◽  
Rebekka Süss ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Arrest ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
First Aid ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Free Interval ◽  
Emergency Medical

Background German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. Objective The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. Methods We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. Results We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. Conclusions Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. International Registered Report Identifier (IRRID) DERR1-10.2196/14358

QUALITY OF LIFE IN URBAN AND RURAL AREAS OF FIVE EUROPEAN COUNTRIES: SIMILARITIES AND DIFFERENCES

2004 ◽  
Vol 6 (1) ◽  
pp. 1-36 ◽  
Author(s):  
HEIDRUN MOLLENKOPF ◽  
ROMAN KASPAR ◽  
FIORELLA MARCELLINI ◽  
ISTO RUOPPILA ◽  
ZSUZSA SZÉMAN ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rural Areas ◽  
European Countries ◽  
Similarities And Differences ◽  
Urban And Rural Areas

scholarly journals Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2314
Author(s):  
Mikolaj Przydacz ◽  
Marcin Chlosta ◽  
Piotr Chlosta
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Rural Areas ◽  
Eastern European Country ◽  
Population Level ◽  
Eastern European ◽  
Level Data ◽  
Urban And Rural Areas ◽  
Eastern European Countries

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

scholarly journals Clinical Practice Guidelines andHelicobacter pyloriInfection in Children

1999 ◽  
Vol 13 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Colin Macarthur ◽  
Liisa Jaakkimainen
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Key Steps ◽  
Evidence Based Guidelines ◽  
Care Costs

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

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