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Der Beitrag diskutiert ausgehend vom Hospiz- und Palliativgesetz (2015) Fragen der Gerechtigkeit in der Gesundheits- und insbesondere in der Palliativversorgung. Die Logik einer gerechten Verteilung nach Bedarf in solidarischen Gemeinschaften wird zunächst gerechtigkeitstheoretisch rekonstruiert. Die Frage der nachvollziehbaren Feststellung des Versorgungsbedarfs erweist sich so als zentrale Gerechtigkeitsfrage. Um aber palliative Versorgungsbedarfe festzustellen, braucht es Vorstellungen eines Normalverlaufs des Sterbens. Auf dieser Grundlage sich etablierende Vorstellungen des „guten Sterbens“ stehen dann in der Gefahr, die Selbstbestimmung von Patientinnen und Patienten zu gefährden. Als besonders schwierig erweist sich die Festlegung eines nachvollziehbaren Versorgungsbedarfs in stark von individuellen Vorstellungen geprägten Lebensbereichen, z. B. wenn es um psycho-soziale und spirituelle Versorgungsbedarfe geht. Das darf aber nicht dazu führen, dass in diesen Bereichen keine Angebote der palliativen Versorgung vorgehalten werden, wie es derzeit im Bereich der allgemeinen Palliativversorgung weitgehend der Fall ist.

Die demographischen und gesellschaftlichen Entwicklungen werden das deutsche Pflegesystem in den kommenden Dekaden vor große Herausforderungen stellen. Insofern lohnt ein Blick über die Grenzen Deutschlands, wie andere europäische Länder mit dieser Aufgabe umgehen. In diesem Zusammenhang wird die Ausgestaltung der Steuerungs-, Finanzierungs- und Leistungsstruktur im schwedischen, niederländischen und spanischen Pflegesystem beschrieben. Darauf aufbauend werden die mit der unterschiedlichen Ausgestaltung der einzelnen Pflegesysteme einhergehenden Anreize theoretisch ausgeführt und die daraus gewonnenen Erkenntnisse im Kontext des deutschen Pflegesystems diskutiert. Dieses bietet aufgrund der zentralen Steuerungsstruktur und der daraus resultierenden einheitlichen Leistungsstruktur Anreize für hohe Verteilungsgerechtigkeit. Ebenso sind Weichen für hohe allokative Effizienz gestellt, da die Finanzierung aus einer Hand keine Anreize zu einer Leistungsverschiebung birgt. Als Nachteil der monistischen und allein an Arbeitseinkommen anknüpfenden Finanzierung kann die Tendenz zu Unterversorgung gesehen werden.

Kernstück des 2009 eingeführten Gesundheitsfonds ist die Einführung des morbiditätsorientierten Risikostrukturausgleichs. Die Einführung des so genannten Morbi-RSA hatte erhebliche Auswirkungen auf die Wettbewerbsposition der Krankenkassen und die finanziellen Anreize zur Weiterentwicklung von Versorgungsstrukturen. In diesem Band des Jahrbuch liegt der Schwerpunkt auf der Weiterentwicklung des Morbi-RSA. Die Herausgeber des Jahrbuchs Risikostrukturausgleich 2009/10 haben daher namhafte Autoren aus Wissenschaft und Praxis eingeladen, dieses Thema aus unterschiedlichen Perspektiven zu beleuchten.

Item does not contain fulltext, BACKGROUND: The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its outcomes be measured through surveys of general practitioners (GPs) and patients?' It will also deal with the process of pooling questions and the subsequent development and application of exclusion criteria to arrive at a set of appropriate questions for a broad international comparative study. METHODS: The development of the questionnaires consisted of four phases: a search for existing validated questionnaires, the classification and selection of relevant questions, shortening of the questionnaires in three consensus rounds and the pilot survey. Consensus was reached on the basis of exclusion criteria (e.g. the applicability for international comparison). Based on the pilot survey, comprehensibility increased and the number of questions was further restricted, as the questionnaires were too long. RESULTS: Four questionnaires were developed: one for GPs, one for patients about their experiences with their GP, another for patients about what they consider important, and a practice questionnaire. The GP questionnaire mainly focused on the structural aspects (e.g. economic conditions) and care processes (e.g. comprehensiveness of services of primary care). The patient experiences questionnaire focused on the care processes and outcomes (e.g. how do patients experience access to care?). The questionnaire about what patients consider important was complementary to the experiences questionnaire, as it enabled weighing the answers from the latter. Finally, the practice questionnaire included questions on practice characteristics. DISCUSSION: The QUALICOPC researchers have developed four questionnaires to characterise the organisation and delivery of primary health care an

Contains fulltext : 96249.pdf (publisher's version ) (Open Access), BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. METHODS/DESIGN: QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey) and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs) and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU) database. Analyses of the data will be performed using multilevel models. DISCUSSION: By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development.

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.