[Cost analysis of the fast track concept in elective colonic surgery]. / Kostenanalyse des Fast-Track-Konzeptes bei elektiver Kolonchirurgie.

INTRODUCTION: Fast track (FT) is a modern concept to enhance postoperative recovery after elective surgery. It has been approved during the last years. Beside its medical benefits, fast-track (FT) concepts may provide an economic incentive, although a cost-benefit analysis in the daily clinical routine has not yet been realised. In addition to this an elevated consumption of resources is postulated. PATIENTS AND METHODS: In 2007 we prospectively studied the implementation of the FT concept for elective colonic surgery in the daily clinical routine at the Department of General Surgery of Nuremberg Hospital. In a representative subgroup of patients studied, we performed a cost-cost analysis by comparing these patients to a retrospectively analysed group that had been treated in a conventional traditional manner in 2002. RESULTS: 369  patients were included and treated according to the FT concept. Discharge criteria were met at the 4(th) postoperative day in median (SD 3.9  days, minimum  1, maxiumum 29  days). The rate of general postoperative complications was 24.4 % (16 % minor complications) for all patients and 6.6 % in the group of patients who were discharged within 9 postoperative days or less (n=182). With respect to the main FT items, implementation of the FT concept was considered as effective. Cost-cost analyses showed a cost reduction of 32 % in favour of patients treated with the FT concept. CONCLUSION: This study clearly shows the clinical and economic benefits of the FT concept considering health services research. Therefore further clinical implementation of the FT concept seems beneficial, not only in the view of medical aspects, but also for economic reasons.

[Current cost analysis in the management of diabetes mellitus]. / Aktuelle Kostenanalysen in der Diabetikerversorgung.

This article considers the costs that arise in the context of the medical management of diabetes mellitus (DM) under different therapeutic regimes. The following evaluations were used in assessing these costs: the LIVE-KK study, a routine data analysis, the LIVE-SPP study, a medical practice data analysis and the LIVE-DE study (a medical practice data survey). Overall the available information indicates that the total cost of the treatment based on insulin gargine is comparable to that incurred with the NPH insulin-based treatment. The treatment showing a medical advantage is thus also the most cost-effective treatment. Another favourable aspect is that patients remain on the combination treatment of insulin glargine with oral antidiabetic drugs longer than is the case with the combination treatment of NPH insulin plus oral antidiabetics.

[Growing market of health services. Starting points for a modern healthcare system]. / Wachstumsmarkt Gesundheit. Ansatzpunkte für ein modernes Gesundheitswesen.

As is the case in other areas of social security services, the German system of statutory health insurance has been battling aggravated financing problems since the mid-1990s. Public discussion in systems similar to Germany that are financed by contributions is mainly typified by the concepts of cost explosion and stability of premium rates. The German healthcare system faces the problem of finding an appropriate control strategy that makes it possible on the one hand to master the exogenous challenges posed by demography, especially advances in medical technology, and on the other hand to ensure that the chances inherent in the "growing market of health services" are not unduly regulated. Against the background of ongoing unemployment, it cannot be considered a long-term solution to continue in regulating a potential employment market with cost-cutting measures or even to favor a healthcare system financed by taxes.

[Cost-of-illness Study for the Treatment of COPD in Germany]. / Krankheitskosten von COPD in Deutschland.

The present cost-of-illness study is focused on the costs of COPD in Germany. In a pre-study, data on 814 randomly selected patients were collected to achieve reliable figures for the distribution of COPD severity grades and the frequencies of exacerbations. The main study was performed on 321 randomly selected patients from the pre-study. Data on resource use were collected in a face-to-face interview with the respective physicians using the patient records as a basis. Costs associated with resource consumption were weighted with the frequencies of COPD severity grades as assessed in the pre-study to determine the costs of COPD. Annual COPD-related costs per patient were 3,027 from the societal perspective. Main cost components were hospitalisations (26 %), medication (23 %) and early retirement (17 %). Annual COPD-related costs from the perspective of the German health insurance system (GKV) were 1,944 euros per patient.

[Economic aspects of zoonoses]. / Okonomische Aspekte der Zoonose.

A significant economic evidence of zoonotic disease can be observed with costs of illness in the range of billions of DM. The lack of competitive structures in the German health care system calls for the use of economic evaluations. By the cautions use of these measures possibilities for rationalizing can be discovered and utilized.

[Managed care. Economic evaluation. Necessity, possibilities and limits]. / Managed Care. Okonomische Evaluation. Notwendigkeit, Möglichkeiten und Grenzen.

The German health care sector is faced with significant structural problems. In addition to existing shortcomings, serious new problems are already on the horizon, and threaten to aggravate the discrepancy between reasonable medical needs and the resources available to finance them. The resolution of this problem requires the use of new tools capable of helping physicians make economically sensible choices. While economic evaluation methods can help point up the economic consequences of various therapies they do nothing more than aid the physician to make decisions, and cannot be allowed to relieve him/her of this responsibility. The principle that medical ethics take preference of economic considerations must remain in place.

[Can quality assurance in medical care be practically implemented?]. / Qualitätssicherung in der medizinischen Versorgung praktisch umsetzbar?

The German discussion on the necessity and form of quality assurance in health care was promoted through legal changes. The objective of quality assurance is to control to assure and to improve quality in health care. For this reason a desired level of quality has to be determined and compared with the actually achieved level. If a deviation of quality is observed, actions for quality improvement are instituted. There are some problems in this context since the level of quality is a result of a patient's individual perception it is very difficult to set a common level. Furthermore the theoretical value of an analysis of deviations is restricted in those areas of health care, in which the relevant data are deeply distorted by statistical outliers caused by a heterogeneous structure of patients and a small number of cases. Therefore, quality assurance is only possible in such areas of medical care, in which numerous identical and non-complex services are provided to patients with a similar morbidity structure.

[Socioeconomic aspects as the limiting factor]. / Sozioökonomische Aspekte als limitierender Faktor.

Even a health system is no exception to the rule that resources are scarce, i.e. only limited financial means are at the disposal of the health sector and thus of medicine. Medically sensible possibilities and needs are constantly growing due to technological progress, i.e. a deficit occurs between possibilities and needs on one hand and financial resources on the other. This leads to a shift in the paradigms of medicine, with functional healthcare being the only feasible alternative to maximum care due to financial shortage. The scarceness of resources thus makes a sparing use of financial means paramount (rationalization) and necessitates the insight that not everything that is medically sensible can also be realized (rationing). All participants must be prompted by means of individual incentives to save costs. It is important that a provision of hardship is established for those who are economically weak. Rationing, i.e. the refusal of effective measures, should take place by waiting lists without any special arrangements for emergencies. Humanitarian reasons do not permit rationing by income or age. "Tight" rationing should occur if the chances of third persons within the system will thereby be diminished, whereas "loose" rationing would be the obvious thing to do, if the system will be relieved because of that.

[Quality assurance in medical care]. / Qualitätssicherung in der medizinischen Versorgung.

The demand for quality assurance in Germany's health care system has been on the increase since promulgation of the Germany Statutory Health Service Reform law. To control, to assure and to improve quality a vast array of different systems is used by health care providers. All these systems work in a similar manner. The desired level of quality is determined and compared with the actually achieved level. If a deviation of quality is observed, actions for quality improvement are instituted. However, there are some problems that make quality assurance a difficult problem. Since the level of quality is a result of a patient's individual evaluation it is very difficult to set a common level. Another problem is to find valid criteria to measure the degree of quality. Finally, further research is necessary to analyse benefits and costs of introducing a quality assurance system.