Challenges for the German Health Care System.

The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.

[School meals at secondary schools: an analysis in the district of St. Wendel in the Province Saarland, Germany]. / Schulverpflegung an allgemeinbildenden Schulen: Eine Analyse im Landkreis St. Wendel, Saarland.

INTRODUCTION: This study focuses on the nutrition of young people in schools. The Saarland state government mandates the implementation of the "quality standards for school meals", developed by the Germany Society of Nutrition (Deutschen Gesellschaft für Ernährung, DGE) in schools offering school meals. This research evaluates the state of implementation. METHODS: 4-week menu plans were evaluated using a stratified random sample of selected schools (n25%-sample=5, ntotal=23). In addition, all catering services of the district (ncaterer=5) were interviewed by written survey focused on any information on the company, the type of food, the menu design as well as general information. RESULTS: None of the analysed menu plans met the DGE standard. The analysis of the menu plans allows for an assessment of the nutritional quality of food. Interviews with caterers provide background information on menu design. DISCUSSION: The analysis of a randomised 25%-sample shows that the target specifications of the DGE are only implemented by a small number of schools in the exemplary selected district of St. Wendel, Germany. As the German Child and Youth Health Survey (KiGGS), also this evaluation shows that the quality of school meals deviates significantly from the recommendations of the DGE. There is a clear need for action.

Adjuvant chemotherapy for colon cancer--analysis of treatment costs from the perspective of statutory sickness funds.

OBJECTIVE: The aim of this study was to calculate sickness funds' costs associated with the application of three different adjuvant chemotherapy regimens for patients with stage III colon cancer treated in different settings (inpatient/outpatient) in Germany. METHODS: Standard procedures according to national guidelines were defined for inpatient and outpatient diagnostics and treatment. Costs associated with the three commonly used standard treatment regimens were calculated from the perspective of statutory sickness funds. RESULTS: The highest costs are associated with the FOLFOX regimen in the outpatient (21530.00 euro) as well as in the inpatient setting (23170.00 euro). Of the two 5-FU bolus regimens, the monthly MAYO-Clinic protocol (inpatient 7070.00 euro vs. outpatient 6610.00 euro) is significantly less expensive than the weekly NSABP protocol (17569.00 euro vs. 12200.00 euro). Costs are remarkably lower in the outpatient setting as compared to inpatient application of the MAYO-Clinic protocol or the FOLFOX regimen. In the outpatient setting, medication costs are the major cost-driving factor, comprising 82% of the total costs of the MAYO-Clinic protocol, 94% of the total costs of the NSABP, and 91% of the total costs of FOLFOX-4 regimen. In the inpatient setting, costs for medications are less important with regard to total costs (10% MAYO-Clinic, 7% NSABP, 10% FOLFOX-4), whereas costs for staff and hotel-like services become more important. CONCLUSION: From a health insurance perspective, substantial cost savings may be realised through the use of established chemotherapy regimens, if most patients are treated in the outpatient setting. In the outpatient setting, costs for drug prices are the main cost driver, so further savings could be realised for third-party payers if prices of chemotherapeutic drugs are reduced. For economic reasons, patients who are candidates for bolus 5-FU regimens, should not be treated according to the NSABP protocol. The MAYO-Clinic protocol is a low cost regimen in both settings, but for medical reasons alternative therapies such as capecitabine or infusional 5 FU protocols must be preferred in patients unable to tolerate the new standard FOLFOX-4.

Cytofluorometric analysis of the neutrophil-specific BH2-Ag on cells from neonates to adults.

Monoclonal antibody (MAB) BH2C6 recognizes a plasma membrane antigen, the BH2-Ag, specifically expressed by human neutrophils. While studies with peripheral blood and bone marrow from healthy adults clearly demonstrate the absence of BH2-Ag from other cellular components except neutrophils, they also indicate that the BH2-Ag is expressed more strongly by mature than immature neutrophils. The purpose of this study was to determine the expression of the BH2-Ag by peripheral blood neutrophils from premature newborns to adults. Seventy-two donors were studied in six age groups: newborns <36 weeks of gestational age; newborns >36 weeks of gestational age; 0.5-2 years; 4-8 years; 12-17 years; >30 years. Expression of the BH2-Ag by peripheral blood neutrophils was examined by cytofluorography using MAB BH2-C6 directly labeled with fluorescein isothiocyanate (FITC). Neutrophils were reacted in parallel with FITC-MAB directed against CD11b, the alpha-chain of the CD11b/CD18 antigen (CR3). BH2-Ag is expressed by 98.3-99.6% of the neutrophils in all groups, and is absent on other blood cells, including those of very premature newborns. Statistical comparisons with respect to the mean fluorescence intensity of the FITC-MAB BH2C6 bound did not support a significant difference in the expression of BH2-Ag in any age group. CD11b expression was also detected in every individual studied and its mean fluorescence intensity correlated significantly with that of BH2Ag (p <0.001). The uniform presence of BH2Ag in every individual including a very premature infant suggests that BH2-Ag is likely to be an essential component of neutrophil development in humans. A highly significant correlation between the mean fluorescence intensity obtained with MAB BH2C6 and MAB CD11b suggests a possible interactive role of the two antigens in neutrophil development and/or function.