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Goal of the Study: An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany., Methods: In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA., Results: In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved., Conclusion: ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The study focuses on the life and work of the German-Jewish neurologist Dr. Ernst Jolowicz who was born in 1882. Originally from Poznan in present-day Poland, Jolowicz had gained his initial professional experience in the German Empire before serving as a neurologist at the Western Front during the First World War. After the war, he opened a private psychotherapeutic practice in Leipzig, published numerous scientific papers and was involved in the General Medical Society for Psychotherapy. In his writings, Jolowicz appeared as an undogmatic adherent of suggestive techniques and came up with his own methods for a patient-centered, psychagogic psychotherapy. In addition, he wrote numerous cultural and social scientific essays showing a wide range of interest. Shortly after the seizure of power by the National Socialists, he emigrated to Paris and supported the anti-fascist resistance in a Strasbourg radio station. After the occupation of France, Jolowicz fled to the United States in 1941 and gained a foothold there once more before he died of a heart disease in New York City in 1958., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: The paper quantifies discrepancies between date of payment and date of service provision when doing analyses in relation to date of death and also in relation to the end of a calendar year. In analyses of this type, time differences between service provision and payment can lead to both under- and overestimation of service use. We aim to capture these phenomena in claims data from different sectors (primary care, medication prescription, prescription of remedies and medical aids, hospital care)., Method: We have used pre-structured claims data from a scientific data warehouse of a large German statutory health insurance covering people that died in 2016. We investigated the discrepancies in time between date of service provision and date of payment for different outpatient and inpatient services based on data from 2015 to 2017. An exact date (dd/mm/yyyy) was only available for data covering prescriptions of remedies and medical aids. Data covering medication prescriptions were only exact to the month of payment (mm/yyyy), whereas data covering outpatient physician care were only exact to the quarter of payment (q/yyyy)., Results: For both outpatient physician care and hospital care, less than 1% had a payment date after the date of death. The share is considerably higher (28-31%) for prescriptions of remedies and medical aids. The majority of payments occurred within 3 months after death (93% for prescriptions of remedies and medical aids, 67% for primary care services). Less than 1% of outpatient physician care and about 18% of remedies had been paid after the end of the calender year 2015. Here too, the majority of payments were made within the first 3 months of 2016 (100% of prescriptions of remedies and medical aids, 65% of primary care services)., Conclusions: Discrepancies in time between date of service provision and date of payment pose a challenge and are a potential source of under-/overestimation of health service utilization when doing analyses in relation to date of death or the end of a calendar year. This needs to be taken into account when requesting the data, but also in preparing and analysing them. The primary recommendation is to ensure that services with a payment date after death are included explicitly., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Eigentümer und Copyright ©Georg Thieme Verlag KG 2019.)

The subjects of this article are field of activity of public health departments and their functionaries that were established as part of the Act to Standardize the Healthcare System (GVG) from July 3 rd , 1934 during the era of National Socialism and in the early post-war period in Thuringia and Württemberg. The objects of study are the implementation of the new paradigm of «racial and hereditary care» in public health departments defined by the Reich's Ministry of the Interior. Furthermore, this paper also examines the role of public health officers (PHO) and their discretionary powers, the impact of the war on PHO's specific activities, as well as the regional particularities in comparison to other federal states and finally, aspects of structural-, programmatic- and personnel continuity in publicly funded healthcare after the liberation in 1945., Competing Interests: Die Autorin gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: This paper analyses schemes to promote the authorisation of and reimbursement for orphan drugs., Methods: 8 countries - Australia, Canada, Germany, Great Britain, France, Netherlands, Switzerland, USA - were studied to compare specific regulations for orphan drugs regarding drug admission, health technology assessment (HTA), decision-making for reimbursement, and off-label and compassionate use. Information was obtained by reviewing published and grey literature. Expert interviews were also conducted., Results: The comparison of orphan drug legislation reveals that the EU and the USA offer the greatest incentives for the development of orphan drugs, whereas there is a tendency for Australia and Switzerland to profit from incentives in other countries. Although not explicitly stated, economic evaluation of orphan drugs takes the special circumstances for orphan drugs into account. In addition to common reimbursement practices, special schemes or programmes for the reimbursement of high-priced orphan drugs exist in all countries that were analysed. Therefore access to orphan drugs seems to be warranted. However, due to co-payments of 5%, the USA may form an exception., Conclusion: On the one hand, the use of special criteria for drug admission, HTA, and reimbursement promotes R&D for orphan drugs. On the other hand, high opportunity costs arise, because huge efforts are made for a minority of patients. A solution for this moral dilemma may be the application of "rule of rescue" or of "no cure, no pay" programmes., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The present paper aims at analysing and discussing managed care with its opportunities and risks. This analysis should be a further basis for a reasonable discussion concerning the implementation of managed care elements in the German Health Care system., Method: On the basis of an update literature research the relevant international experiences with managed care in several health care systems--especially in the United States and Switzerland--are analysed and described. Most relevant opportunities and risks of managed care are deduced from this analysis., Results: The most important opportunities of managed care are the stabilisation of health care costs, an improvement of health care processes and quality and a stronger consideration of preventive measures. The possibility of choosing between several health care models and more convenient health insurance fees are opportunities for the patients. Relevant risks of managed care involve the potential withholding of medical care with the necessity of a comprehensive quality assurance and negative influences on the physicians' autonomy. Furthermore, managed care may have negative effects on the relationship between patients and physicians or between general practitioners and medical specialists., Conclusions: Managed care has proven advantages in respect of cost stabilisation and quality improvement compared with traditional health care systems. If the risks and known problems of managed care are realised and avoided, the available opportunities could be an important option to reform the German Health Care system in respect of costs and quality.

Objective: According to the president of the "Wissenschaftstrat", Prof. W. Schulze, the university is in the center of research and scientific development. The contributions of the different anesthesia departments of all german universities in international anesthesia and intensive care medicine journals were studied in a descriptive analysis., Methods: A Medline analysis covering the past 10 years was focused an all contributions from anesthesia departments from all german universities (n = 37). Contributions in important international anesthesiology and intensive care journals were separately analysed., Results: Within the investigation period of 10 years contributions in all Medline-listed international journals increased (1988:55 contributions-1997:236 contributions). There was a wide variety in the activity among the different university departments ranging from no publication up to a total of 132 publications. Only a few university departments of anesthesia contributed to the increase in papers in international intensive care journals (1988: 11 publications-1997:35 publications)., Conclusion: Marked differences in the numbers of publications of the different universities in anesthesia and intensive care medicine journals were observed. Universities from former East Germany are still less involved in international publications.

Background: Cat scratch disease (CSD) is a relatively common cause of chronic lymphadenopathy in the USA. In the present paper the authors describe recent advances in the understanding of this disorder focusing on etiology, clinical aspects, diagnostic management, and therapy., Etiology: Rochalimaea henselae and Afipia felis, two gram-negative bacteria, have recently been isolated from lymph node tissue of patients suffering from CSD. The current literature reveals that Rochalimaea henselae seems to be the most probable agent responsible for CSD. Serum samples from CSD patients' cats have shown titers of 1:64 or higher for antibodies to Rochallmaea henselae., Epidemiology: The incidence of CSD in the USA is between 0.77 and 9.3 per 100,000 per year. The incidence of CSD in Europe is unknown, but the prevalence of antibodies to Rochalimaea henselae among cats is comparable., Clinical Manifestations: Most common symptoms of CSD are regional lymphadenopathy, fever, and malaise. Other manifestations occur in about 5% of patients and include encephalitis, granulomatous hepatitis, and Parinaud's oculoglandular syndrome. Fatal complications and irreversible sequelae have not been reported., Diagnosis: To establish the diagnosis of CSD, the presence of regional lymphadenopathy, cat contact, and papula are required. Additional procedures include indirect fluorescent antibody assays and PCR., Therapy: Up to now there is no standard therapy for CSD. Antibiotic treatment, however, might be considered for CSD patients with severe symptoms. Rifampicin, ciprofloxacin, trimethoprim sulfamethoxazole, and gentamicin are known to be effective antibiotic agents.

German psychiatrists do not have an easy access to Adolf Meyer. The reasons include: his influence on American psychiatry was mainly exercised by his personal influence; he did not have the gift of writing his important and influential ideas in a clear language; these ideas, furthermore, were scattered over great number of papers in a variety of periodicals; there is only one unsatisfactory (from the point of view of edition) collection of Meyers papers; no textbook of Meyerian psychiatry exists. There seems to be no German translation of any of Meyers papers. Meyer, who was always in close contact with German psychiatry and psychiatrists, transmitted their ideas to the American scientific public, although in a critical vein. His own psycho-biological or genetico-psychodynamic theory pointed to the importance of the biological and personality structure and its reactions, of how the patient reacts to which live events and which illness in his or her body contrasts to Kraepelins concept of self-sufficiency of the endogenous psychoses. Whereas DSM I und II had been moulded in Meyers spirit, DSM III led far away from it.