[Salomon Neumann (1819-1908) and the Right to Health]. / Salomon Neumann (1819­1908) und das Recht auf Gesundheit.

The "Universal Declaration of Human Rights (UDHR)" of the United Nations (UN) of 1948 sets out a right to health as a common ideal and aspiration. In his writings on the reform of the Prussian Medical Charter "Public Health and property" 100 years before the UDHR was set out, the Jewish physician Salomon Neumann had defined health as a right for every citizen, a right that should to be protected by a public system of health care. His reasoning went beyond contemporaneous critical social discussion. Right of humans to health has been acknowledged nationally and internationally; in the Federal Republic of Germany, the question as to whether there is a basic right to health is still open.

[Social Security Needs Social Medicine: Self-image of Physicians Practicing Social Medicine in Statutory Health Insurances and Social Security Systems]. / Soziale Sicherheit braucht Sozialmedizin Selbstverständnis von Ärztinnen und Ärzten in der sozialmedizinischen Begutachtung und Beratung.

OBJECTIVE: In January, 2014, the division "Social Medicine in Practice and Rehabilitation" of the German Society for Social Medicine and Prevention established a working group on the self-image of the physicians active in the field of social medicine (medical expertise and counseling). METHODS: The result of this work is the contribution presented here after consensus was achieved by specialists of social medicine from different fields and institutions (social security etc.) and in good cooperation with Prof. Dr. Gostomzyk and Prof. Dr. Robra. RESULTS: Based on the importance of an up to date social medicine for claimants and recipients of benefits on the one hand and the social security system on the other, and also on a description of the subjects, objectives and methods the following aspects are presented: · The perspective of social medicine. · Qualification in social medicine, concerning specialist training and continuing medical education. · The fields of duty of experts in social medicine. · The proceedings in social medicine. The working group identified challenges for the specialists in social medicine by a narrowed perception of social medicine by physicians in hospitals and practice, accompanied by an enlarged importance of expertise in social medicine, by the demand for more "patient orientation" and gain of transparency, and concerning the scientific foundation of social medicine. CONCLUSIONS: The working group postulates: · The perspective of social medicine should be spread more widely.. · Confidence in experts of social medicine and their independency should be strengthened.. · The not case-related consulting of the staff and executives should be expanded.. · Social medicine in practice needs support by politics and society, and especially by research and teaching.. · Good cooperation and transfer of experiences of the different branches of social security are essential for the impact of social medicine..

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]. / Bedeutung der personbezogenen Faktoren der ICF für die Nutzung in der praktischen Sozialmedizin und Rehabilitation.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Perspectives in rehabilitation. General position paper on future trends and challenges in rehabilitation by the Health Advisory Board of the German Federal Association for Rehabilitation]. / Perspektiven der Rehabilitation. Ein Positionspapier des Arztlichen Sachverständigenrates der Bundesarbeitsgemeinschaft f ü r Rehabilitation (BAR) zur Weiterentwicklung der Rehabilitation.

The Health Advisory Board of the German Federal Association for Rehabilitation (BAR) describes future trends and challenges in rehabilitation as deriving from the socio-demographic development in Germany and the structural characteristics of its Social and Health Care Insurance System. The focus is on elder employees to sustain and regenerate their capacity for employment, on people which are no longer employed to activate their autonomy and ability for self-support, and on rehabilitation as a holistic and integrative process extending through the social security and health insurances. There is an urgent need and a real chance to benefit from already existing scientific findings more frequently and to integrate them effectively into adequate further education and training programmes for professionals. Finally the conclusion summarises 8 theses to facilitate rehabilitation as an integral and essential part of the German social security and health sector. This paper was fully accredited by the members of the BAR Managing Board.

[Random sampling according to section 17 c KHG--report on the experience of maximal care hospitals in Hesse]. / Die Stichprobenprüfung nach 17 c KHG--Erfahrungsbericht aus Krankenhäusern der Maximalversorgung in Hessen.

Hospital billing converted to "German diagnosis-related groups" (G-DRG) for in-patient treatment in Germany is reviewed, except in psychiatry where per-diems are still in use. Currently thousands of bills are sent to the Medical Service for scrutiny. In addition, the law relating to Hospital Financing (Krankenhausfinanzierungsgesetz, para. 17 c) provides for systematic checks on a random sample of bills from a given hospital. The Medical Service of the Social Security Health Insurance reports on the experience in the State of Hessen. Present regulations exclude from the random sample those bills that have already been presented for a check on a case by case basis. Excluding these cases from the random sample introduces a bias in an avoidable way. The present rule is contrary to valid conclusions from the random sampling and should be abolished.

[The position of the sociomedical expert in the Medical Services of German Statutory Sickness Insurance Bodies (MDK) as influenced by changing challenges]. / Zur Stellung des sozialmedizinischen Experten im Medizinischen Dienst der Krankenversicherung (MDK) unter dem Einfluss sich wandelnder Anforderungen.

The "Medical Services of the German Statutory Sickness Insurance Bodies (MDK)" is a non-profit organisation providing socio-medical specialist advice to the German Statutory Health and Nursing Care Insurances. Facing demographic changes as well as progress in medicine, highly qualified expertises and consultations are of increasing importance to manage the social security system and to continue to develop its structure. Sociomedical assignments of the MDK as applied health science is so far mainly related to individual aspects of insured persons (case management) but more and more to general aspects such as quality, consumer protection, efficiency, guiding concepts and organisation of the health care system. Based on its widespread experience, profound knowledge and confidence in its expertise the MDK is aware of its great sociopolitical responsibility and faces the wide range of assignments with regard to personneldevelopment and organisational innovations. Identification with principles of genuine medical practice, creating a modern job profile, and exercising creative power in accordance with the fundamental social legislation. This characterises the self-image and roleperception of medical experts of the MDK.

[Tasks and function of the German Medical Review Board of the Statutory Health Insurance (MDK). Latest aspects in dermatology in view of social medicine]. / Aufgaben und Funktion des Medizinischen Dienstes der Krankenversicherung (MDK). Aktuelle Aspekte in der Dermatologie aus sozialmedizinischer Sicht.

The German Medical Review Board of the Statutory Health Insurance (MDK) is a sociomedical service for impartial medical opinion and consultation. Together with the statutory health insurance companies it takes part in shaping the public health care system. Many recent developments are changing the german health insurance system. This article illustrates the complex sociomedical framework of MDK's activities in relation to current issues in dermatology. The article focuses on: new diagnostic and therapeutic methods, drugs (off-label-use), out-patient and in-patient dermatological rehabilitation and hospital treatment.

[Study of the quality of codification of diagnoses and procedures under DRG conditions]. / Untersuchung zur Qualität der Kodierungen von Diagnosen und Prozeduren unter DRG-Bedingungen.

UNLABELLED: A system based on Diagnosis Related Groups was introduced in Germany and is mandatory for hospitals from 2004. Hospitals, health care providers and the Medical Service of Social Security-Health Insurance (MDK) face a common effort. Proper codification of diagnoses and procedures is essential. The Medical Service in the State of Hessen, the Techniker Krankenkasse and the Burgerhospital Frankfurt am Main combined forces to assess codification under the DRG system. GOALS: The partners cooperated to assess actual codification and to identify starting points for improvement. METHODS: A random sample was taken from all in-patient cases (all departments) over a 6-month-period (n = 309). Codification or coding was checked according to German Coding Rules (Deutsche Kodierrichtlinien) from the complete hospital records. Different codification, or coding, was discussed between MDK and Hospital doctors. RESULTS: The actual data revealed overcoding in 34 per cent of diagnoses and in 15 per cent of procedures. Undercoding was present in 9 per cent of diagnoses and in 2 per cent of procedures. The DRG grouping changed in 68 cases (22 per cent) after scrutiny by the Medical Service (MDK). The case-mix index (CMI) calculated from relative weights as coded by the hospital was 0.84. The case-mix index calculated from coding by MDK was 0.81. The CMI calculated from effective weights was 0.77 (hospital) and 0.75 (MDK). DISCUSSION: Causes of faulty coding and possible remedies are presented. CONCLUSIONS: Further systematic reviews are required to develop the DRG System and identify faulty trends.

[Analysis of the actual state of nutrition of elderly patients fed via PEG tube]. / Ist-Analyse der Ernährungssituation von mit PEG-Sonde versorgten älteren Menschen.

Over a period of six months starting from October 1, 2001, within the frameworks of quality checks in nursing homes and the examination to check the need of care, the data of 290 persons supplied with a PEG-tube were collected. In only 60% of all cases the individual weight had been recorded. For 40% of the group the most important regulatory parameter for calorie intake was not available. Weights which had not been measured were estimated by the MDK experts. In total, 27% of the PEG patients were underweight. Assuming an activity factor of 1.2 the minimal required amount of calories was calculated on the basis of age, height, weight and sex and compared with the actual calorie intake. Up to 19% of the patients with PEG were mainly fed orally. About half of these people could probably be nourished without a PEG. 66% of all people were fed exclusively via PEG. 47% of them received less calories than their basal metabolic rate (BMR), 70% received less than their minimal energy requirement. On average, the calorie intake was 171 kcal below the BMR. In those cases, where either an external nutrition expert was consulted or the actual weight was known, the share of patients receiving less than the required amount of calories was slightly lower. Within the framework of persons surveyed for the check of a need of care, the situation of those being taken care of in their private home surroundings was considerably better than of those who were living in a nursing home.

[The future of social medicine from the practical viewpoint]. / Die Zukunft der Sozialmedizin aus praktischer Sicht.

Within the German statutory health care system the practice of sociomedicine as an applied health science is mainly related to individual aspects of theinsured persons. Combining factors due to medical and socio-economical developments it plays an important integrative role as so to say a lawyer of the patients. Furthermore, practical sociomedicine must provide consultant services to support the social insurance in the sphere of shaping the health care system. Profound knowledge on the required level must be acquired by graduate studies and can be deepened by well-planned continuing medical education. Professionalism in providing services and fulfillment of legal obligations can be achieved by standardisation of social medical procedures, scientific orientation towards public health aspects, appropriate methods of delivering medical knowledge, use of information systems, refinement of co-operation, quality management, social medical controlling, application of modern planning and control concepts as well as model leadership.

[How many intensive care beds are necessary? A quantitative study with the Therapeutic Intervention Scoring System (TISS) in 5 Hessian hospitals)]. / Wie viele Intensivbetten sind notwendig? Eine quantitative Untersuchung mit dem Therapeutic Intervention Scoring System (TISS) in fünf hessischen Krankenhäusern.

In five major Hessian hospitals all patients of critical care units have been grouped according to the Therapeutic Intervention Scoring System (TISS) over a time span of four weeks. The objective was to establish the critical care patient capacity needed in accordance with the Hessian Guidelines for Critical Care. Sample surveys showed that the ascertained data are highly reliable. 10,756 TISS-classifications have been evaluated in total. 9.4% of the classifications have been assigned to general ward, 27.5% to intensive monitoring and 63.1% to intensive treatment. Assuming a standard rate of use of 85% over the year this revealed an average requirement of critical care patient capacity of 6.1% of the total number of beds. The results of the investigation were readily accepted by health insurances and hospitals involved.

["Managed care"--perspectives in Germany]. / "Managed care"--Perspektiven in Deutschland.

There is a public discussion in Politics and Health services whether managed care should be realized in Germany. The German Medical Services of the Statutory Health Insurance (MDK) are also involved and have great interest and an opinion about this topic because the introduction of managed care or elements of managed care will influence the cooperation between the MDK and the German Statutory Health Insurance. The following article informs on certain elements of managed care already practised in Germany and discusses which of these elements can be used more intensively in the future according to Social Laws and developed structures.

[An instrument for evaluating the psychiatric personnel regulation]. / Ein Instrumentarium zur Evaluation der Psychiatrie-Personalverordnung.

Since 1991, the Psychiatrie-Personalverordnung (Psych-PV) regulates the allocation of personnel in German psychiatric hospitals and psychiatric wards. Psych-PV defines the personnel's diagnostic and therapeutic tasks based on an illness severity scale. A group of experts from the Medical Advisory Services of Social Security--Health Insurance (MDK) has developed a questionnaire as an instrument to systematically gather, from a given hospital, structural data relevant for application of Psych-PV. The questionnaire consists of two parts, relating to the hospital and to the individual wards. The hospital supplies information such as statutory catchment area, types of care offered, capacity, personnel, organisational structure, patients' diagnoses, and co-operation with complementary institutions. The section pertaining to individual wards collects data on admission and discharge, duration of treatment, re-admissions, and internal transfer. The distribution of the severity of patients' illnesses within individual wards, which has been defined in the budget, is the basis for a review of the actual number of staff as well as of the realization of basic tasks of diagnostics and treatment. Questions pertaining to treatment concepts in individual wards are aimed to ascertain the degree of agreement with the conceptual goals of Psych-PV. The methods of treatment offered in a given ward can be gleaned from its weekly organisation-plan. Indications for the realization of basic tasks of diagnostics and treatment can be derived from the information supplied by each personnel group of a ward with regard to specific tasks of individual and group treatment. The questionnaire developed by the MDK in Hessen allows to review the extent to which the allocation of staff according to Psych-PV on the level of the individual ward translates into appropriate treatment options. The questionnaire also offers a basis for a comparison of hospitals.

[Certification according to DIN EN ISO 9001 in MDK in Hessia--a report of experiences]. / Zertifizierung nach DIN EN ISO 9001 im MDK in Hessen--ein Erfahrungsbericht.

Quality assurance is a routine and indispensable part of the work of the Medizinische Dienst der Krankenversicherung (MDK) (Medical Services of statutory health insurance bodies in Germany). To optimize the internal organisational processes, a quality assurance system (QAS), certified by EQ Zert, Ulm (an accredited certifier of the TGA), was implemented for the first time in one of the departments of the MDK, namely, the hospital department. Employees and management consider the advantages to be as follows: the aims of the department are clearly described. the processes are now self-evident and more strictly observed, overlaps to other fields of the company are defined. Both an Error Management System with follow up measures, and a Project Management System to control projects have been implemented. The documentation system was standardized, and consequently relocating documents has become more streamlined. An MDK self-evaluation was performed as part of an internal audit. The audit showed that the QAS of the hospital department of the MDK in Hesse is indeed highly developed. It is anticipated that gradually other fields of the MDK will also be certified, to comply with the changing requirements.