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Background of National Quality Policy . Workshop 1 ENQual Programme NIVEL, Utrecht 28.11.2003. G. Ollenschläger 1 G. Winker-Komp, C. Thomeczek 1. 1 German Agency for Quality in Medicine AQuMed (Joint Institution of GMA and NASHIP, Cologne)

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Background of National Quality Policy

Workshop 1 ENQual Programme

NIVEL, Utrecht 28.11.2003

G. Ollenschläger 1 G. Winker-Komp, C. Thomeczek 1

1 German Agency for Quality in Medicine AQuMed

(Joint Institution of GMA and NASHIP, Cologne)

2 German Ass. for Quality Assurance in Health Care


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Outline

Germany – Some background information

Quality in health care – an actual topic in Germany

Health care reform 2003 and quality


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Source: Statistics Division and Population Division of the United Nations Secretariat


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Structure of the German Social Security System

Achberger 2000


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German Health Care SystemBasic Features

  • Statutory Social Health Insurance System

    • covers about 90% of population

  • Principle of Solidarity

    • financial contributions differ

    • equal benefits to all insured

  • Pluralism

    • Federal government, state governments, self-regulating corporate bodies

  • Delegation of power to non-governmental corporate bodies

    • Providers Associations

    • Sickness Funds Associations

Marcial Velasco Garrido, 2002


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Who defines the Benefit Catalogue?

Possible Health Benefits

Marcial Velasco Garrido, 2002

German Parliament

Service Framework

Federal Standing Committee of Physicians and Sickness Funds

Benefit Catalogue

Medical Review Board of the Sickness Funds

Sickness Funds

Social Courts


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Health Insurance Systems in Germany

Achberger 2000


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German Network of Quality Agencies (Owned / sponsored by Self Governing Partners)

RV

BÄK

KBV

GKV

PKV

DKG

AWMF

DPR

BMG

Agency for

Quality in Medicine

KTQ

(Cooperation for

Transparency and Quality

in Healthcare)

Committee of

Physicians +

Sickness Funds

Federal

Office for

Quality Assurance

Germ. Assoc.

for Quality Ass.

in Healthcare

Guideline Clearing

Accreditation Progr,

Disease Manag.

Programmes, HTA

Quality Assess.

in Hospitals

Evaluation of

Quality Programmes

Stobrawa, 2002


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German Agency for Quality in Medicine

AQuMed Steering Group

(Representatives of German Medical Association and

National Assoc. of Statutory Health Insurance Physicians)

GGC Steering Group

GMA

NASHIP

Nat. Hosp. Ass.

Statut. Sickn.F.

Priv. Insuran.F.

Publ.Pension

Insur.Funds

German Guideline Clearinghouse

Patient Information Clearinghouse

PIC Steering Group

GMA

NASHIP

Disabled People Ass.

Health Care Consum. Ass.

Self Help Gr.A.

Office for CPG Implementation

Center for

Evidence Based Medicine

Office for Quality Progr. Clearing

Task Force Patient Safety –

Error Prevention

AQuMed Executive

Communication,

Information

Programme

Management

Research and Development

Training,

Education

Website

www.aezq.de

Expert Committees & Panels

Journ. for CME, Qual.Ass. ZaeFQ

Guideline Appraisal Groups

Guideline Appraisal Groups

Guideline Appraisal Groups

Guideline Appraisal Groups

Guideline Appraisal Groups


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Quality problems in Germany ?Where is the evidence ?


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Problems with the German Healthcare System ?

  • Deficits in quality, economic efficiency, transparency and patient orientation.

  • Challenges for health insurance due to aging population, medical progress and changes in people's working lives.

  • Financing of health insurance, being solely dependent on income, leads to increasing incidental wage costs and therefore to negative effects on the labour market.

Press Release, Fed. Government 2003-08-01


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Outcomes in German Health Care

Busse 2002


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Nurse assessed quality of care, 98/99 Aiken et al, 2001

US CA EN SC DE

% confident that their

patients are able to

manage their own care

when discharged 33.8 30.0 59.7 56.1 80.9

% who say the quality

of care in their hospital

has deteriorated

in the last year 44.8 44.6 27.6 21.5 17.2

Busse 2002


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Total Expenditures on Health- % of GDP -

Increasing contribution rates 13,5% to 14,5% (2002)

  • Source: WHO 2000


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2003: the Year of the Reform

Goals of the newest health care reform

  • Stabilise contribution rates

  • Increase quality and efficiency of care

  • Develop competitiveness among providers

  • Strengthen patients rights

  • Uphold basic principles

    • Solidarity

    • equal right to treatment for all insured citizens


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Stat. Health Ins. Modernisation Act 2003 - Measures

Strengthening of patient sovereignty

  • Patient representative at federal level

  • Consumer information by Inst. for Quality and Econ. Efficiency in SHI

    Improving quality of care

  • Inst. for Quality and Econ. Effeciency in SHI (foundation of self governing partners): assessment of guidelines, recommendations on national disease management programmes, assessment of benefits of medicines, HTA.

  • Standard quality management for in-patient and out-patient services.

  • Mandatory CME


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Assessment

Appraisal &

Guidance

Feedback

NICE

Dissemination

Monitoring

Implementation

Evidence-Based Practice

in Healthcare

Identification

Littlejohns, NICE

NICE – A New Model for Germany ?


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What about Professional Self-regulation ???

Littlejohns, NICE


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1996

1997

1998

1999

2000

2001

2002

Implementation of systematic Quality oriented + Evidence based Healthcare in Germany (by Self Governing Partners)

„Evaluation“ Phase

Testing, assessment

of tools / procedures

„Orientation“ Phase

Analysis of the international state of the art

„Routine“

  • Institutionalisation

  • Guidelines Clearinghouse

  • Nat. Disease Manag. Programme

  • HTA for definition of benefits

  • Quality measure for hospitals

  • Peer groups for outpat. care

  • DRG‘s + TQM in hospitals

„Development“ Phase

Development of methodological standards, networking (international/ national)

Perleth & Schwartz 2001, modified


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Thanks for your patience !!!!

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