www.azq.de 1 background of national quality policy g. ollenschläger 1 g. winker-komp, c. thomeczek...
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1www.azq.de
Background of National Quality Policy Background of National Quality Policy
Background of National Quality Policy Background of National Quality Policy
G. Ollenschläger 1 G. Winker-Komp, C. Thomeczek 1
1 German Agency for Quality in Medicine AQuMed German Agency for Quality in Medicine AQuMed(Joint Institution of GMA and NASHIP, Cologne)(Joint Institution of GMA and NASHIP, Cologne)
2 German Ass. for Quality Assurance in Health Care German Ass. for Quality Assurance in Health Care
Workshop 1 ENQual ProgrammeNIVEL, Utrecht 28.11.2003
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Germany – Some background information
Quality in health care – an actual topic in Germany
Health care reform 2003 and quality
OutlineOutlineOutlineOutline
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Population in rural areas
Per capita GDP Unemployment People aged 60+
82 million 13 %
$25.468 9.8 %
23.2 %
Source: Statistics Division and Population Division of the United Nations Secretariat
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Structure of the German Structure of the German Social Security SystemSocial Security System
SSoocciiaall SSeeccuurriittyy SSyysstteemm
SSoocciiaall IInnssuurraannccee SSyysstteemm
Statutory Insurance: Health Insurance Long Term Care Retirement Insurance Unemployment Accidents & Disease
(only work related)
FFeeddeerraall CCaarree PPrrooggrraamm Special Plans for Persons in the Service of the State: Policemen Soldiers Civil Servants etc.
WWeellffaarree SSyysstteemm Special Plans for Low Income Persons: Unemployed Persons Handicapped Persons Single Parents Elderly Persons etc.
Achberger 2000
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German Health Care SystemGerman Health Care SystemBasic FeaturesBasic Features
• Statutory Social Health Insurance SystemStatutory Social Health Insurance System– covers about 90% of population
• Principle of SolidarityPrinciple of Solidarity– financial contributions differ– equal benefits to all insured
• PluralismPluralism– 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?Who defines the Benefit Catalogue?
PoPosssible Health sible Health BenefitsBenefits
Service Service FrameworkFramework
BenefitBenefit CatalogueCatalogue
German Parliament
Federal Standing Committee of Physicians
and Sickness Funds
Medical Review Board of the Sickness
Funds
Sickness Funds
Social Courts
Marcial Velasco Garrido, 2002
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Health Insurance Systems in GermanyHealth Insurance Systems in Germany
SSttaattuuttoorryy HHeeaalltthh IInnssuurraannccee TTyyppee ooff IInnssuurraannccee PPrriivvaattee HHeeaalltthh IInnssuurraannccee
Compulsory Insurance Legal State Individual Contract
Non-Profit Organization Profit Orientation Profit Organization
Depends on Income (~ 13%),
not on Individual Risk
Insurance Premiums (half-and-half rule)
Depends on Individual Risk,
not on Income
Federal Plan,
Ruled by Law,
equal Access for all Members
Health Care Services Insurance Plan,
Ruled by Individual Contract,
Access depends on Individual
Risk and Contract
Insurance pays the Services
directly (Payment in Kind)
Reimbursement of the Health Care Services
Patient pays the Services,
amount will be reimbursed
9900%% RRaattee ooff tthhee eemmppllooyyeedd PPooppuullaattiioonn
1100%%
Achberger 2000
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German Network of Quality Agencies German Network of Quality Agencies (Owned / sponsored by Self Governing Partners)(Owned / sponsored by Self Governing Partners)
KTQ(Cooperation for
Transparency and Qualityin Healthcare)
AWMFKBV DKGBÄK GKV BMGDPRPKV
Agency for Quality in Medicine
Committee ofPhysicians +
Sickness Funds
FederalOffice for
Quality Assurance
Guideline ClearingDisease Manag.
Programmes, HTAQuality Assess.
in Hospitals
Accreditation Progr,
Evaluation of Quality Programmes Stobrawa, 2002
RV
Germ. Assoc.for Quality Ass.
in Healthcare
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Guideline Appraisal GroupsGuideline Appraisal Groups
AQuMed Steering Group (Representatives of German Medical Association and
National Assoc. of Statutory Health Insurance Physicians)
AQuMed Executive
Guideline Appraisal GroupsGuideline Appraisal GroupsGuideline Appraisal GroupsExpert Committees &
Panels
Office for CPG Implementation
German Guideline Clearinghouse
Center for Evidence Based Medicine
Patient Information Clearinghouse
German Agency for Quality in Medicine
Office for Quality Progr. Clearing
GGC Steering Group
GMANASHIPNat. Hosp. Ass.Statut. Sickn.F.Priv. Insuran.F.Publ.PensionInsur.Funds
PIC Steering Group
GMANASHIPDisabled People Ass.Health Care Consum. Ass.Self Help Gr.A.
Task Force Patient Safety –Error Prevention
ProgrammeManagement
Research and Development
Training,Education
Communication,Information
Journ. for CME, Qual.Ass. ZaeFQ
Websitewww.aezq.de
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www.g-i-n.net
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Agency for Health Research & Quality AHRQ, US Agency for Quality in Medicine ÄZQ, DEAGREE CollaborationAssociation of Scientific Medical Societies AWMF, DEBasque Office for HTA OSTEBA, ESBelgian Center for Evidence based Medicine CEBAM, BEBerlin Chamber of Physicians, DECenter for Health Policies and Services CPSS, RO Center for Reviews & Dissemination York CRD, GBClinical Epidemiology Center Lausanne CepiC, CHDanish Center for Evaluation and HTA DACEHTA, DKDirectorate for Health and Social Affairs, NODirectorate for Health Iceland, ISDutchAssociation of Comprehensive Cancer Centres ACCC, NLDutch College of General Practitioners NHG, NLDutch Institute for Healthcare Improvement CBO, NLevidence.at -Austrian Ass.for Quality in Healthcare, ATFederal Committee of Physicians and Sickness Funds FCPS, DEFinnish Medical Society Duodecim, FIFinnish Office for HTA FINOHTA, FIFlemish College of General Practitioners WVVH, BEHTA Unit, Ministry of Health Malaysia, MY Institute for Quality in Healthcare IQS, PTItalian Evidence-Based Medicine Group GIMBE, IJ .Briggs Inst.for Evid.Based Nursing&Midwifery, AU J osep Laporte Library Foundation, Barcelona FBJ L, ESNat.Agency for Accred., Eval in Healthcare ANAES, FRNat. Board of Health and Welfare (Socialstyrelsen), SENational Federation of French Cancer Centres FNCLCC, FRNational Institute for Clinical Excellence NICE, GBNational Institute of Clinical Studies NICS, AUNational Kidney Foundation NKF, USNew Zealand Accident Compensation CorporationACC, NZNew Zealand Guidelines GroupNZGG, NZ Polish Institute for Evidence Based Medicine PIEBM, PLProgram in Evidence-based Care, Cancer Care Ontario PEBC, CARegional Health Agency Emilia-Romagna ASR, IRoyal College of Surgeons in Ireland RCSI, IE Royal DutchAss. of Physiotherapy KNGF, NLScottish Intercollegiate Guidelines NetworkSIGN, GBSlovene Guidelines Group SGG, SISowerby Centre for Health Informatics at Newcastle SCHIN, GBSpanish Network for Research on Guidelines REDEGUIAS, ESSwiss Medical Association FMH, CHTrimbos Institute – Neth.Inst.of Mental Health & Addiction, NLWorld Health Organisation Geneva WHO
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1. France
2. Italy3. San Marino
4. Andorra5. Malta
6. Singapore7. Spain
8. Oman9. Austria
10. Japan11. Norway
12. Portugal13. Monaco
14. Greece
15. Iceland16. Luxembourg17. Netherlands18. United Kingdom19 Ireland20. Switzerland
21. Belgium22. Columbia
23. Sweden24. Cyprus
25.25. GermanyGermany26. Saudi Arabia
34. Denmark37. United States
WHO Evaluation 2000WHO Evaluation 2000OOverall Health Care System Performance verall Health Care System Performance -- Efficiency Efficiency
Quality problems in Germany ?Quality problems in Germany ?Where is the evidence ?Where is the evidence ?
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Problems with the German Problems with the German Healthcare System ? Healthcare System ?
• Deficits in quality, economic efficiency, transparency and Deficits in quality, economic efficiency, transparency and patient orientation.patient orientation.
• Challenges for health insurance due to aging population, medical progress and changes in people's working lives.
• Financing of health insuranceFinancing 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 CareOutcomes in German Health Care
Busse 2002
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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
Nurse assessed quality of care, 98/99 Nurse assessed quality of care, 98/99 Aiken et al, 2001Aiken et al, 2001
Busse 2002
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• Source: WHO 2000
10,5%
8,0%
13,7%
5,8%
10,1%9,2%
8,0%
6,2%5,3%
9,0%8,0% 7,6% 8,0% 7,6%
9,8%8,8%
6,5% 6,2%
8,2%
9,4%9,3%
Total Expenditures on HealthTotal Expenditures on Health - % of GDP -
Increasing contribution rates 13,5% to 14,5% (2002)
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2003: the Year of the Reform2003: 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 Stat. Health Ins. Modernisation Act 2003 - 2003 - MeasuresMeasures
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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Feedback
NICE
AssessmentAssessment
IdentificationIdentification Appraisal & Guidance
Appraisal & Guidance
DisseminationDisseminationDisseminationDissemination
ImplementationImplementation
MonitoringMonitoring
Evidence-Based PracticeEvidence-Based Practicein Healthcarein Healthcare
NICE – A New Model for Germany ?NICE – A New Model for Germany ?
Littlejohns, NICE
19www.azq.deLittlejohns, NICE
What about Professional Self-regulation ???What about Professional Self-regulation ???
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Implementation of systematic Quality oriented + Implementation of systematic Quality oriented + Evidence based Healthcare in Germany Evidence based Healthcare in Germany
(by Self Governing Partners)(by Self Governing Partners)
Perleth & Schwartz 2001, modified
„„Orientation“ PhaseOrientation“ PhaseAnalysis of the international
state of the art
„„Development“ PhaseDevelopment“ PhaseDevelopment of methodological
standards, networking (international/ national)
„„Evaluation“ PhaseEvaluation“ PhaseTesting, assessment of tools / procedures „„Routine“Routine“
InstitutionalisationInstitutionalisation• 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
1996 20011997 1998 1999 2000 2002
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Thanks for your patience !!!!Thanks for your patience !!!!
• www.azq.de
• www.leitlinien.de
• www.patienten-information.de
• www.g-i-n.net
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