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Domestic violence evidently endangers health. Since physicians are seen as primary contact persons by victims of violence it is necessary to understand their perception of their role. 1346 of all physicians and dentists registered in 2015 with the Saxony Board of Physicians filled in a questionnaire on contact with victims, knowledge on support structures and willingness to take part on specific medical education. Frequency of contact was estimated to be low, while readiness to approach patients in case of suspicion was high. There was uncertainty about where to refer, as well as a limited level of awareness of existing support structures. Most indicated a high request in further education. In conclusion, motivation and readiness contrast with uncertainty and lack of awareness. Education focusing on key players and major network interfaces should endorse physicians in their significant role within the care and prevention system of violence.Häusliche Gewalt ist laut Studien gesundheitsgefährdend. Ärzt*innen werden von Gewaltopfern als primäre Ansprechpersonen wahrgenommen. Zur Prävention weiterer Gewalt interessiert deren Wahrnehmung von sich selbst als Schlüsselstelle. 1346 bei der Sächsischen Landesärztekammer 2015 gemeldete (Zahn-)Ärzt*innen beantworteten einen Fragebogen zum Kontakt mit Betroffenen, zu Hilfestrukturen und zu Fortbildungen zum Thema. Sie äußerten eine geringe Kontakthäufigkeit zu Betroffenen bei hoher Bereitschaft, Patient*innen bei Verdacht anzusprechen. Es fand sich Unsicherheit bei der Weitervermittlung sowie eingeschränkte Bekanntheit vorhandener Hilfestrukturen. Hohe Bereitschaft gab es für weitere Fortbildung. Zusammenfassend bestehen einerseits Motivation und Bereitschaft, andererseits Unsicherheit und Unkenntnis bezüglich der Thematik häusliche Gewalt und spezifische Hilfestrukturen. Fortbildungen mit Fokus auf zentrale Vernetzungsinhalte und Schnittstellen sollten Ärzt*innen bei der Wahrnehmung ihrer Rolle im Hilfesystem unterstützen.

The approval of the first digital health applications (DiGA) in October 2020 resulted in a lot of buzz - not only in the healthcare sector but also beyond. The integration of DiGA to the public healthcare system was seen as a significant innovation and stakeholders worldwide were looking to Germany. How did the start of the DiGA innovation project go and what is the current standing? The first months of DiGA becoming part of standard care brought new experiences and knowledge to manufacturers, doctors and patients as well as to health insurance companies and associations. More than six months later, it is time for a preliminary review.This article looks at the achievements so far as well as the status quo of DiGA in the market as of March 2021. It also focuses on current and upcoming challenges that the various stakeholders face on the way to integrate DiGA into standard care in a widespread and sustainable way.Die Zulassung der ersten digitalen Gesundheitsanwendungen (DiGA) im Oktober 2020 sorgte für Aufsehen – nicht nur innerhalb des Gesundheitswesens, sondern auch darüber hinaus. Denn die Aufnahme von DiGA in die gesundheitliche Regelversorgung war weltweit ein Novum. Auch international blickten daher viele Interessierte nach Deutschland. Wie verlief der Start des Innovationsprojekts DiGA und wo stehen wir heute? Die ersten Monate, in denen DiGA Teil der Regelversorgung wurden, haben für Hersteller, Ärzt:innen und Patient:innen sowie für Krankenkassen und Verbände neue Erfahrungen und Erkenntnisse mit sich gebracht. Mehr als ein halbes Jahr später ist es Zeit für ein erstes Zwischenfazit.Dieser Bericht wirft einen Blick auf das bisher Erreichte und den Status quo, an dem sich DiGA im März 2021 im Markt befinden. Er widmet sich ebenso aktuellen und künftigen Herausforderungen, denen sich die verschiedenen Akteur:innen auf dem Weg zu einer flächendeckenden und nachhaltigen Integration von DiGA in die Regelversorgung gegenübersehen.

There is a lack of integration of appropriate digital health applications (DiGA) into the first healthcare market in Germany. In order to enable a valid and reliable use of previously examined digital health products, their implementation into services of the statutory health insurance (SHI) is necessary. The aim of this study was the development of strategies to modify and improve access of DiGA to SHI reimbursement. The recently introduced Digitale-Versorgung-Gesetz (DVG) is an initial step in this direction. Using a qualitative approach, focus group interviews were conducted with key stakeholders of existing access paths. Previously elaborated problem-solving approaches were discussed. The approaches ranged between adapting existing structures and implementing an original digital pathway. Subsequently, a comparison of the project results and legislative provision of the DVG was carried out. The proposed approaches were discussed heterogeneously and varied depending on the position of the participants. The implementation of an Advisory Council had a greater consensus than the introduction of a digital-specific pathway. Also individual measures like administrative support for generating the necessary evidence was considered as positive and beneficial. However, a deviation from the current evidence standards should be avoided. Furthermore, the legitimacy and time expenditure for the digital-specific pathway was called into doubt. In principle, a better focus on existing structures on digital health applications can be endorsed. For a short-term use of DiGA potentials, adaptions of existing structures are preferable. The DVG legislation, although conforming to the project results only to some degree, can be considered as a first step. An amendment, in particular from the viewpoint of diagnostic or therapeutic DiGA, appears to be necessary.Nutzstiftende digitale Gesundheitsanwendungen (DiGA) sind bislang nicht hinreichend in den ersten Gesundheitsmarkt integriert. Um eine gezielte und sichere Anwendung von geprüften digitalen Produkten zu ermöglichen, sollte jedoch die Implementierung in das Leistungsspektrum der gesetzlichen Krankenversicherung anvisiert werden. Die Studie zielte auf die Entwicklung von Lösungsstrategien zur Verbesserung der Zugangsmodalitäten von DiGA in das deutsche Gesundheitssystem ab. Ein erster Schritt in diese Richtung wurde zwischenzeitlich mit Einführung des Digitale-Versorgung-Gesetzes (DVG) vorgenommen.Im Rahmen qualitativer Fokusgruppeninterviews wurden die relevanten Stakeholder zentraler Zugangswege zu 3 im Vorfeld entwickelten Reformoptionen befragt. Diese reichten von der Anpassung bestehender Strukturen an die Anforderungen digitaler Lösungen bis hin zur Einführung einer originären Leistungskategorie für DiGA. Die Auswertung erfolgte mittels zusammenfassender Inhaltsanalyse. Abschließend werden die Projektergebnisse den Vorgaben des DVG gegenübergestellt.Die 3 Lösungsstrategien wurden heterogen und positionsabhängig diskutiert. Der größte Konsens konnte hinsichtlich der Einführung einer zentralen Beratungsstelle beobachtet werden. Auch Einzelmaßnahmen aus der ersten Reformoption, wie die Schaffung eines Erprobungsverfahrens zur Generierung notwendiger Evidenz, wurden als sinnvoll bewertet. Dennoch wurde mehrheitlich darauf hingewiesen, dass eine Aushöhlung des bestehenden Evidenzniveaus grundsätzlich zu vermeiden sei. Gleichwohl entsprechende Vorteile im Vergleich zu den anderen Lösungsvorschlägen gesehen wurden, ist insbesondere die Einführung einer gänzlich neuen Leistungskategorie kritisch bewertet worden. Gegenargumente waren der zeitliche Aufwand sowie die fragliche Legitimation eines DiGA-spezifischen Zugangsverfahrens.Die grundsätzliche Anpassung bestehender Strukturen auf die spezifischen Anforderungen digitaler Versorgungslösungen wurde als sinnvoll bis notwendig erachtet. Um Potenziale von DiGA kurzfristig sinnvoll nutzen zu können, sollten primär Anpassungen an den bestehenden Strukturen und Verfahren vorgenommen werden. Das DVG ist als erster Schritt positiv zu bewerten, stimmt jedoch nur bedingt mit den Ergebnissen und Einschätzungen aus den Fokusgruppeninterviews überein. Insbesondere mit Blick auf diagnostische und therapeutische DiGA scheinen die Neuregelungen noch nicht umfassend genug zu sein.

The National Action Plan to Improve Health Literacy calls for user-friendly and health-competent development of health care at all levels. After the first years of focusing on individual health literacy, the focus is increasingly on organizational health literacy. Organizational health literacy addresses different standards (e. g., management, communication, staff, users or patients) and levels in the organization (i.e., organizational, staff and user level). Numerous tools already exist to strengthen health literacy in hospitals. However, previous studies have rarely focused on a differentiated overview of tools to strengthen organizational health literacy by health literacy standards and differentiated by level of organization, staff and users. The article has two goals, one of which is to search for and review existing tools to strengthen organizational health literacy in health care institutions. In addition, selected tools for strengthening organizational health literacy for health care institutions, differentiated according to the eight fields of action and the three organizational levels (i.e., institution, staff, users), will be presented.A search was carried out to identify tools on strengthening health literacy in facilities of health care. All the tools identified were reviewed, selected according to previously defined inclusion and exclusion criteria and assigned to the level (institution, employees or patients/clients and their relatives) as well as the eight fields of action of organizational health literacy.We found a total of N=191 tools for health care facilities. After taking into account the inclusion and exclusion criteria, a total of n=60 tools were selected and differentiated according to the level and standard of organizational health literacy. Some of these tools could be assigned to more than one field of action. Most tools (n=37) were found for Standard 5 "Health-competent communication users", while the lowest number of tools were identified for Standard 7 "Promoting the health literacy of employees" (n=4). Differentiation by level (i. e., organizational, staff, patients or clients) shows that there is a smaller number of tools for employees (n=43) compared to the level of the organization (n=76) or users (n=65).Overall, the study shows that numerous tools already exist to strengthen organizational health literacy for hospitals, in particular, and for health care settings, in general. In the future, however, it will be necessary to develop and test tools for individual standards of health literate organizations in health care facilities. Further, internationally provided and tested tools have to be adapted and piloted for the German-speaking countries and health care settings in order to address the health literacy of staff, users and their relatives in a sustainable manner.The development of health literate settings requires effort from health care organizations. Thus, tools for strengthening organizational health literacy should be provided and implemented by also focusing on the level of organization, staff and users so that the individual health literacy of users can be addressed and improved in the long-run.

In Germany, the number of patients with dementia is expected to increase from 1.7 (2017) to more than 3 million people (2050). Preventive and therapeutic measures target at early stages of dementia such as mild cognitive impairment (MCI). Aim of the study is to compare prevalence rates of MCI and dementia over time.The study was based on the complete nation-wide outpatient claims data of the panel doctors services according to § 295 SGB V. We identified prevalent patients with MCI (PwMCI) and with dementia (PwD) in the years 2009 to 2016 treated by general practitioners or neuropsychiatric specialists.The number of prevalent PwMCI/PwD increased from 50,760/1,014,381 (2009) to 166,919/1,416,319 (2016) and the corresponding prevalence rates from 0.13 % to 0.42 % (MCI) and from 2.52 % to 3.55 % (dementia), resp.Despite the significant prevalence gain, the number of PwMCI identified in outpatient health claims data is much lower than the expected number of 2,8 to 3,7 million people at the population level. Therefore, we anticipate a further increase in the number of PwMCI being treated in the outpatient sector over the coming years.ZIEL: In Deutschland wird ein Anwachsen der Patienten mit Demenz von 1,7 Mio. (2017) auf über 3 Mio. (2050) erwartet. Präventive Maßnahmen und Therapien zielen auf frühe Phasen der Demenzerkrankung, wie der leichten kognitiven Störung (MCI). Die Behandlungsprävalenzen für MCI und Demenz der Jahre 2009 – 2016 werden vergleichend dargestellt.Datengrundlage bildeten die bundesweiten vertragsärztlichen Abrechnungsdaten gemäß § 295 SGB V. Für die Jahre 2009–2016 wurden in Hausarzt- und Facharztpraxen behandelte prävalente Patienten mit leichten kognitiven Störungen (PmMCI) und Demenz (PmD) identifiziert.Die Anzahl prävalenter PmMCI/PmD wuchs von 50 760/1 014 381 (2009) auf 166 919/1 416 319 (2016) und die entsprechende Behandlungsprävalenzrate von 0,13 % auf 0,42 % (MCI) bzw. von 2,52 % auf 3,55 % (Demenz).Trotz des deutlichen Zuwachses bleibt die Behandlungsprävalenz der abrechnungsrelevant dokumentierten PmMCI weit unter der geschätzten bevölkerungsbezogenen Anzahl von 2,8–3,7 Mio. prävalenter PmMCI. In den nächsten Jahren ist daher mit einer weiteren Zunahme der PmMCI im ambulanten Versorgungsbereich zu rechnen.

As is the case in other sectors, innovative digital products have started to enter the health market, too. If digital products like apps are considered medical devices, startups are often confronted with regulatory procedures that they deem to be slow and with which they are not familiar. This applies to both the certification procedures and the requirements and procedures for reimbursement, where problems could occur. The aim of this article is to better understand the startups' experience in navigating through these procedures, the hurdles they encounter, and their need for support. Therefore, the digital association Bitkom e. V. and the Federal Institute for Drugs and Medical Devices (BfArM) conducted a web-based survey on five themes with a total of 23 questions. These questions focused inter alia on the composition of the team, product planning, familiarity with regulatory requirements, experience with institutions and different sources of information, the assessment of challenges in the process, and the resulting need for support.The analysis on the basis of 18 complete replies has shown that startups work on products with documentation and communications functions, but also integrate diagnostic and therapeutic features. The latter are characteristics of medical devices. Startups consider themselves to be relatively familiar with regulatory requirements regarding medical devices. The largest hurdles are associated with reimbursement: long and costly processes until the startups' products could be reimbursed.Both with regard to reimbursement and certification, startups see a need for low-threshold, cost-efficient advisory services and a simplification and acceleration of existing procedures with regard to medical devices.

Digital health products and services have started to fundamentally change healthcare and prevention. Products intended for a medical use require CE-marking and potentially certification (ISO 13485) of the company. Startups play an important role in the development of new digital products and services. Two startups share their experience with these processes. Becoming a part of standard care and hence being reimbursed is a challenge for startups. For this reason, startups pursue alternative sources of income, too. The statutory health insurance's procedures for assessing new products and services are perceived as long. Startups are required to provide evidence of the benefit of their product at an early stage in the procedure. This requires time-consuming and costly studies. Startups would therefore appreciate support in generating this evidence, e. g. through adequate procedures for testing.

Legitimately categorizing software in the healthcare sector is complex. According to European medical devices law, software can be considered a medical device. The decisive factor is whether the software is used for directly controlling a therapeutic or diagnostic medical device or as stand-alone software that achieves specific medical purposes, as they are described in the legal definition of a medical device. A contribution of the software to diagnosis or therapy can be sufficient for the categorization; it does not have to provide the complete diagnosis or the complete therapy itself.This principle will continue to be the same with the new Regulation on Medical Devices (EU) 2017/745, even though the classification rules have been more closely and more specifically tailored to software and more stringent requirements for essential safety and performance requirements have to be met.

This article analyzes the financial (out-) performance of all listed health care companies. The health care sector outperformed the market in the period from 2000 to June 2015. The performance was driven by companies from Americas, and Asia as well as companies from the pharmaceuticals sub-segment. Additionally, bull periods appear to be the main driver for the outperformance. Euro-based investors can expect different outcomes of their investments to those of USD investors. However, the main trends remain unchanged.

The 40 years of separated development in two countries with extremely different political and social utopias allow consideration of the connection between science and society. The society-dependent development of cerebrospinal fluid (CSF) diagnostics in the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG) is shown in the context of the international scientific development of the post-war era with new paradigms in physics, biology and genetics. As part of this contribution to the philosophy of science the consequences of the complex life science for a new view of disease research are discussed in contrast to the currently dominating, reductionistic medical industrial complex.

Die Pflegebranche ist durch steigende Belastungen der Mitarbeiter und eine hohe Personalfluktuation gekennzeichnet. Bisherige Studien konnten bereits zeigen, dass Führungskräfte Einfluss auf die Gesundheit und das organisationale Commitment ihrer Mitarbeiter nehmen. Es blieb aber unklar, durch welche Wirkzusammenhänge sich dieser Einfluss beschreiben lässt, zumal weitere Studien die Bedeutung sozialer Belastungen und Ressourcen hervorheben. In der vorliegenden Studie wurden mittels Fragebogen Mitarbeiter der stationären Altenpflege (n = 861) zu ihrem Gesundheitszustand, ihrem organisationalen Commitment, ihren sozialen Belastungen und Ressourcen sowie der Gesundheitsorientierung ihrer Führungskräfte befragt. Die Ergebnisse bestätigten den Zusammenhang zwischen gesundheitsorientierter Führung und Gesundheit und Commitment der Mitarbeiter. Soziale Ressourcen und Belastungen am Arbeitsplatz mediieren diesen Zusammenhang dabei teilweise. Die Ergebnisse untermauern die Bedeutung einer gesundheitsorientierten Führung für die Gesundheit und das Commitment der Mitarbeiter. Die Förderung der sozialen Ressourcen und Reduzierung der Belastungen stellen für Führungskräfte zentrale Ansatzpunkte zur Förderung der Gesundheit und des Commitments ihrer Mitarbeiter dar.

The aim of the study was to present a picture of consumers' views on the specific market of health and health products, the second German health market. Market analysis of the product categories was carried out.A large-scale representative survey (N=1 033) determined with an innovative adaptation of the repertory grid method the consumer's perspective on the specific market. Basic questions concerning attitudes to health as well as healthy behaviors completed the telephone survey.In the saturated markets, market for health is growing, especially in the context of aging societies, and this is not limited to primary medical products. In this study, product categories such as "dental care", "fruit and vegetables" or "nuts" were classified as healthy products.The relevance of health also in the macroeconomic context has been long underestimated. Health has still a high priority for consumers. A disclosure of individual perceptions in the health context provides a significantly more relevant product design. The identification of healthy product dimensions from the consumer's perspective sheds light on the actually desired product properties and the available potential to meet these desires.Ziel der Studie war eine Abbildung der individuellen Konsumentensicht auf den sehr speziellen Markt für Gesundheit bzw. Gesundheitsprodukte, den zweiten deutschen Gesundheitsmarkt. Eine visuelle Verortung der untersuchten Produktkategorien im Zuge einer Marktanalyse ergänzte diese Visualisierung.Eine großangelegte repräsentative Studie (N=1 033) ermittelte mit einer innovativen Adaption der Repertory-Grid-Methode die Konsumentensicht auf den betrachteten speziellen Markt. Grundlegende Fragen bzgl. der Gesundheitseinstellung sowie dem praktizierten gesunden Verhalten komplettierten die telefonisch umgesetzte Befragung.Gesundheit stellt in gesättigten Märkten, vor allem auch unter dem Aspekt alternder Gesellschaften, einen Wachstumsmarkt dar, welcher sich bei Weitem nicht auf originäre medizinische Produkte beschränkt. In der hier vorgestellten Studie wurden Produktkategorien wie „Zahnpflege“, „Obst und Gemüse“ oder „Nüsse“ als gesunde Produkte klassifiziert.Die Relevanz von Gesundheit, auch im gesamtwirtschaftlichen Kontext, ist lange unterschätzt worden. Nach wie vor nimmt Gesundheit für Konsumenten einen hohen Stellenwert ein. Eine Offenlegung der individuellen Wahrnehmungen im Gesundheitskontext bietet eine Möglichkeit der deutlich effektiveren Produktgestaltung. Die Identifikation gesunder Produktdimensionen aus Konsumentensicht bringt so Aufschluss über die tatsächlich gewünschten Produkteigenschaften und die daraus resultierenden vorhandenen Potenziale.

Economizing health care systems has led to industrialized hospitals. The consequences and side effects are substantial and rather promote costs explosion due to the dictated increase in cases and efficiency. Hence, position sensing and change in direction are required. Effective ways to find out of the current crisis are discussed.

Infection prevention is one of the main tasks of the public health services. The "Protection against infection act" places all medical institutions and facilities for children (kindergartens and schools) under the obligation to assume responsibility and to cooperate. Duties of the institutions are described, and public health services are obliged to perform hygiene control visits.Regarding medical institutions, the guidelines of the German Commission on Hospital Hygiene and Infection Control have to be observed, and the counties were obliged to publish hygiene enactments. Subsequently, good improvements in hygiene management in medical institutions were achieved. In schools, however, severe hygienic problems (i.e. sanitary hygiene, indoor air hygiene) are detected, without any improvement - obviously due to a missing sense of responsibility in the school community. Causes for poor behaviour prevention (hand hygiene, ventilation) and missing situational prevention (i.e. cleaning) are discussed. Without reversion to the obviously needed but nearly forgotten subject school hygiene, obligatory guidelines and the assuming of responsibility, permanent improvements cannot be achieved.

Business companies, which in the current times also includes hospitals, must create customer benefits and as a prerequisite for this must sustainably generate profits. Management in the world of business means the formation and directing of a company or parts of a company on a permanent basis, whereby management in this context is not exercising power but function. This concept of management is exemplary developed in this article for the important services sector of the operating room (OR) and individual functions, such as resource control, capacity planning and materials administration are presented in detail. Some OR-specific management challenges are worked out. From this it becomes clear that the economic logic of the most efficient implementation possible is not a contradiction of medical ethics, enabling the most effective treatment possible for patients while safeguarding the highest possible levels of safety and quality. The article aims to build a bridge for medical specialists to the language and world of commerce, emphasizing the profession-based competence and hopefully to arouse interest to go into more detail.

The aim of this study was to gain insight into worksite health promotion in small and medium-sized companies compared to large concerns in Middle Franconia. Action in worksite health promotion, obstacles and demand for networks for workplace health promotion were determined.A standardised telephone interview served for collecting data for this cross-sectional study. The interviewee was always the manager or their proxy. 106 companies were contacted. The results of this study were analysed via qualitative and quantitative methods in SPSS(®) 20.It was possible to reach and interview 80 companies, a return rate of 75.5%. More than half the companies (68.8%) implemented at least one activity for worksite health promotion, especially ergonomic measures and measures to promote physical activity. Taking the size of the company into consideration when analysing the results, previous study results are confirmed. With an increasing size of the company, the relative frequency of measures for workplace health promotion rises. The motivation for worksite health promotion ranges from keeping the employees healthy (38.2%) to worksite health promotion as part of the business culture (9.1%). 81.1% of the companies consider their activity in worksite health promotion to be successful. Furthermore, 80.0% of the firms that implemented worksite health promotion were supported by a partner like a health insurance (43.2%). Those companies that did not implement any activities for worksite health promotion, state as a prime reason that they did not think about it as yet (44.0%). Besides, 44.0% of the companies without any worksite health promotion would like to implement measures. 65.5% of the companies that already took action in worksite health promotion and 56.0% of the companies that did not would like to cooperate with other firms in a network for workplace health promotion. Mutual exchange is the most important factor for them.The results of this study show that almost half of the companies that did not implement measures for worksite health promotion as yet would like to take action in this regard. For a bigger establishment of worksite health promotion, networks are predestinated and are best accompanied and supported by external professionals like health insurances, mutual indemnity associations or universities.

Advanced competencies and tasks of nurses go along with an increasing interest of pharmaceutical companies and manufacturers in nurses as a marketing target.To identify nurses' attitudes, perceptions and behavior regarding industry and marketing strategies.1) Systematic literature search in Medline via PubMed and CINAHL for international studies on nurses' conflict of interests towards pharmaceutical companies; 2) analysis of a survey with PhD students from two Nursing Science doctoral programs.The review including 16 publications published between 1999 and 2014 and the survey among 82 PhD students revealed comparable results. The majority of nurses already had contact with pharmaceutical companies. Nurses are often uncritical in their attitudes, and suggestibility is claimed to be low. The majority of nurses were not - or at least not sufficiently - provided with conflict of interest training, neither as part of their vocational training nor their continuing education.Conflict of interest seems to be an important topic for nurses. Increasing relevance in the future underpins the need for making nurses more sensitive towards this issue, especially through professional training programs.

In the space of a decade, the Lake Geneva region has become the Health Valley, a world-class laboratory for discovering and developing healthcare of the future. Through visionary individuals and thanks to exceptional infrastructure this region has become one of the most dynamic in the field of innovation, including leading scientific research and exceptional actors for the commercialization of academic innovation to industrial applications that will improve the lives of patients and their families. Here follows the chronicle of a spectacular expansion into the Health Valley.

The effectiveness of the risk management systems established by medical device manufacturers and health-care facilities is clearly mitigated by European and national legal provisions. Laws, regulations and authorities prevent the systematic exchange of much safety-relevant information. The obligation to report adverse events is suspended for many relevant risks associated with medical device use. Reporting into the vigilance system is of little avail for users. Reporting even may endanger the information provider. The federal fragmentation of the German vigilance system poses a risk for patients. Risk management in health-care facilities without risk policy is dangerously incomplete.

The following study examines the influencing factors on the satisfaction of oncological patients with their primary care physician, specialist physician, hospital and health insurance provider. Individual patient satisfaction with cross-sectoral collaboration is examined based on the satisfaction with these sectors.12 specialist practices from 8 federal states participated in the patient survey. Altogether, 516 patients took part during the investigation period 2011-2012. The results were evaluated by multiple regression analysis.The results show that patients are content with cross-sectoral collaboration if they are satisfied with their health insurance and the specialist physician. With regard to satisfaction with the primary care physician and the specialist physician, trust is perceived to be the most important influencing factor. For hospitals, the most significant influencing factor is interest in and time for patients. Regarding health insurance, providing the patients with information leads to a greater degree of satisfaction.Psychosocial factors are of key importance for the patient's perceptions of satisfaction with the different sectors. This contains for instance factors like to 'putting confidence in physicians' or 'talking about patients' fears'. The sectors considered in this study should therefore give more consideration to these factors during patient care. A health insurance provider can take on the role of a competent point of contact, providing quality-assured information in the context of oncological diseases.

The Hessian Care Monitor is a Web-based monitoring system of the regional care labor market. It contains information on the current labor market and on future developments. Official statistics are analyzed, primary data are collected, and forecasts are calculated. Since 2008, the demand for nurses in Hesse has been higher than the supply. In 2010, there was a lack of more than 4,400 nurses. Moreover, in 2025, around 5,500 additional nurses will be needed to meet the increasing demand arising from demographic changes. However, there are three different regional patterns: regions with high current shortages but little additional demand in the future; regions with low current shortages but large future needs; and regions with high current shortages and large future demand. Appropriate strategies for handling labor shortages have to be selected according to the different regional patterns.

Overcoming rigid sectoral segmentation in healthcare has also become a health policy target in quality assurance. With the Act to Enhance Competition in Statutory Health Insurance (GKV-WSG) coming into effect, quality assurance measures are to be designed in a cross-sectoral fashion for in- and outpatient sectors equally. An independent institution is currently mandated to develop specific quality indicators for eleven indications. For three of these operating tests have already been commissioned by the Federal Joint Committee. This article depicts the major results of a feasibility study, including a compliance cost estimate, for the aforementioned indications of cross-sectoral quality assurance (cQA). In conclusion, a number of both practical and conceptual basic challenges are still to be resolved prior to the full implementation of cQA, such as a sufficient specification to activate documentation requirements and an inspection system capable of separating actual quality problems from documentary deficits. So far, a comprehensive cost-utility analysis of cQA has not been provided, in particular with comparison to existing QA systems. In order to optimise cost and utility of cQA an evidence-based approach is required for both the extension of cQA areas and for QA provisions.

To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) in the model region Rendsburg-Eckernförde on costs and effectiveness of care.In a prospective controlled cohort study 244 patients with a diagnosis according to ICD-10: F10, F2 or F3 were interviewed in the model region (MR) and compared to 244 patients from a control region (CR) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HONOS, SCL-90 R/GSI, PANSS, BRMAS/BRMES), functioning (GAF, SOFAS), quality of life (EQ-5 D) and service use/costs (CSSRI).Subjective symptom severity (GSI) and functioning (GAF) developed more favourably in the MR than in the CR, the HONOS score developed slightly worse in the MR. The latter effect occurred mainly in ICD-10: F10 patients, while patients with F2/3 rather did benefit under RPB conditions. The development of total costs of care was not different between MR and CR. The potential to reduce costs of in-patient care was low due to the initially low capacity of inpatient beds.The RPB did not reduce the total costs of mental health care, but certain diagnosis groups may benefit from improved trans-sectoral treatment flexibility.

Cross-sectoral integrated health-care and the regional psychiatry budget are two models of cross-sectoral health care (comprising in-patient and out-patient care) in Germany. Both models of financing were created in order to overcome the so-called fragmentation in German health care. The regional psychiatry budget is a specific solution for psychiatric services whereas integrated health care models can be developed for all areas of health care. The purpose of this overview is to elucidate both the current state of implementation of these models and the results of evaluation research.Systematic literature review, additional manual search.28 journal articles and 38 websites referring to 21 projects were identified. The projects are highly heterogenuous in terms of size, included populations and services, aims, and steering-function (concerning the different pathways of care).The projects yield innovative models of mental health care capable of competing with the co-existing traditional financing systems of in-patient and out-patient services. The future of mental health care organisation in Germany is currently open and under political discussion.