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 Quality Assurance in German Health Care System  Peter Hermanek M. D. Munich, Bavaria, Germany.

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Presentation on theme: " Quality Assurance in German Health Care System  Peter Hermanek M. D. Munich, Bavaria, Germany."— Presentation transcript:

1  Quality Assurance in German Health Care System  Peter Hermanek M. D. Munich, Bavaria, Germany

2 Proportion of income for the social system  old age pension19.9% limit €  unemployment 3.3%  health care15.5%limit €  disabled care 1.95% total 40.65%

3 Health care costs and Gross domestic product 2006  USA15.3 % Germany10.6 % Hungary 8.3 % Poland 6.2 %  per headUSA6 714$ Germany3 371$ Hungary 1 504$ Poland 910$

4 Health care system in Germany  Inpatient care  Outpatient care

5 Health care costs Germany  10.6% of gross domestic product  inpatient care Billion € in %

6 Proportion of Inpatient care costs 2006  Italy45% Germany 35% Hungary28% USA26 %

7 Basic data 2006 Germany Inhabitants  acute hospitals total2 104  general hospitals (incl. university hospitals)1 809  hospitals psychiatry/neurology 295  prevention and rehabilitation hospitals 1 255

8 Basic data 2006 Germany  employees  medical doctors  nurses

9 1 809 acute hospitals  public614(34 %)  denominational692(38 %)  private503(28 %)  beds

10 Health Care in Germany  mandatory health insurance (99% of the population)  free access  no waiting lists (so far)

11 Health Care in Germany  prices are fixed by the state  Rules and details are defined by the partners first, not by politics

12 Key questions  Do we get adequate quality in regard to the amount of spent resources ?  Cost effectiveness ?  Cost-quality effectiveness ?  How to measure quality ?

13 External Quality Assurance  In god we trust, everybody else has to bring data Dwight Eisenhower

14

15 Obstetics: Tendencies  cesarian sectio rate26% (tendency ) range7% - 40%  mortality birthweight < 1 000g % % %

16 mandatory QA  cholecystektomy  appendecectomy  hernia repair  carotid-TEA  obstetics  hip fracture  endoprothesis  coronary angiography  cardiac pacemakers  stroke patients  pneumonia

17 Cholecystectomy

18 Commissions of experts  work normally with anonymised data  inform the hospital and ask for explanation and consequencies  peer visitation

19 Social Law  hospitals must introduce quality management system  standards of quality (structure, results)  mandatory structured quality reports  catalogue for volume-outcome relationship

20 §135a german social law .... hospitals must systematically ask for their own quality of care and take efforts towards continous improvement (PDCA - cyclus) .... a management method based upon efforts of all persons working in hospital independant from classic hierarchies

21 QM - competing methods  DIN EN ISO  EFQM  KTQ/ProCumCert  JCAHO (international)

22 quality reports  treatment data  quality data (structure und results)  health insurances must publish reports via internet  health insurances can make rankings and recommendations for patients, public...

23 Referenzwert 2,0 Qualitätsergebnisse nach Gallenblasenoperationen Qualitätsmerkmal „Erneuter Eingriff“ Erläuterung des Schaubildes: In Hamburger Kliniken sind nur selten erneute Eingriffe nach einer Gallenblasenoperation, die mit der Schlüssellochtechnik ausgeführt wurde, erforderlich. Mit 1,3% liegt der prozentuale Anteil unter dem Bundesdurchschnitt (1,68%) und deutlich innerhalb des Referenzbereiches für gute Qualität, (Obergrenze bei 2%)

24 volume-outcome  catalogue of elective procedures with evidence-based correlation of volume and outcome  no reimbursement in case of not coming up to number

25 volume-outcome catalogue  liver TX20/year  kidney TX25/year  oesophageal surgery10/year  pancreatic surgery10/year  stemcell TX25/year  knee-endoprotheses50/year

26 2006: 182 Abt. n =

27 Times get harder !

28  Thank you very much further information:


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