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This article adopts a comparative approach exploring the reactions to the scarcity of resources resulting from the Covid-19 pandemic in Italy and Germany. Both countries showed a fragmented structure including individual hospitals, medical associations and recommendatory interdisciplinary bodies, such as ethics councils. Against this background, the authors use the different constitutional frameworks in which the healthcare systems are embedded to assess the legitimacy of the intervention by non-legislative bodies. It is demonstrated that, in both jurisdictions, a certain level of parliamentary involvement in establishing triage criteria or procedures is constitutionally required, as in situations of extreme scarcity the prioritisation decision cannot be determined by a mere clinical analysis but rather demands a normative choice. [ABSTRACT FROM AUTHOR]

Background: The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis. Methods: Anonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013. Results: Epistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups. Conclusion: The outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets. [ABSTRACT FROM AUTHOR]

Abstract: No health system in the world can provide all patients with the best possible care. Nevertheless, different countries spend different proportions of their gross domestic expenditure on health care – the UK spends 6.9%, Italy 7.6%, France 9.6%, Germany 10.5% and the USA 14.2%. Perhaps the key question is: ‘How much should we spend on health care?’ However, this contribution focuses on the question: ‘Given that there is only a limited amount of money available for health care, how should we spend it?’ Resource allocation decisions involve a bewildering array of possible criteria. Some resource allocation theorists have attempted to formulate general theories or principles that can help us think through allocation decisions. This contribution begins by distinguishing different levels of allocation decision, then examines a hypothetical case study to illustrate the range of factors that can be appealed to in allocation decisions. Three theoretical attempts that have been made to deal with the complexity of allocation factors are also discussed – the quality-adjusted life-year (QALY), lottery theory and needs theory. [Copyright &y& Elsevier]

Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations., Objective: This study describes the establishment and management of a CCCC at a German university hospital., Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered., Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found., Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient's life against another's., (©Nikolas Schopow, Georg Osterhoff, Nikolaus von Dercks, Felix Girrbach, Christoph Josten, Sebastian Stehr, Pierre Hepp. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 18.11.2021.)

The concept of the International and Inter-Society Co-ordination Committee (I2C2) has been introduced at the International Society for Heart and Lung Transplantation (ISHLT) annual meeting in Prague. It is a pivotal role of I2C2 to develop formal relationships with other societies involved in the field of thoracic transplantation to attain mutual benefits, share membership, and achieve common goals. This editorial is on behalf of an initiative of the I2C2 committee chairs to report about a specific problem related to thoracic transplantation in 1 European country and the approach chosen by the local national authorities, together with the transplant community, to address this issue., (© 2013 International Society for Heart and Lung Transplantation. All rights reserved.)