1. www.azq.de 1 Background of National Quality Policy G. Ollenschläger 1 G. Winker-Komp, C. Thomeczek 1 German Agency for Quality in Medicine AQuMed 1 German Agency for Quality in Medicine AQuMed (Joint Institution of GMA and NASHIP, Cologne) German Ass. for Quality Assurance in Health Care 2 German Ass. for Quality Assurance in Health Care Workshop 1 ENQual Programme NIVEL, Utrecht 28.11.2003

2. www.azq.de 2 Germany – Some background information Quality in health care – an actual topic in Germany Health care reform 2003 and quality OutlineOutline

3. www.azq.de 3 Source: Statistics Division and Population Division of the United Nations Secretariat

4. www.azq.de 4 Structure of the German Social Security System Achberger 2000

5. www.azq.de 5 German Health Care System Basic Features German Health Care System Basic 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

6. www.azq.de 6 Who defines the Benefit Catalogue? Possible Health Benefits Service Framework Benefit Catalogue 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

7. www.azq.de 7 Health Insurance Systems in Germany Achberger 2000

8. www.azq.de 8 German Network of Quality Agencies (Owned / sponsored by Self Governing Partners) KTQ (Cooperation for Transparency and Quality in Healthcare) AWMFKBVDKGBÄKGKVBMGDPRPKV Agency for Quality in Medicine Committee of Physicians + Sickness Funds Federal Office for Quality Assurance Guideline Clearing Disease Manag. Programmes, HTA Quality Assess. in Hospitals Accreditation Progr, Evaluation of Quality Programmes Stobrawa, 2002 RV Germ. Assoc. for Quality Ass. in Healthcare

9. www.azq.de 9 Guideline Appraisal Groups AQuMed Steering Group (Representatives of German Medical Association and National Assoc. of Statutory Health Insurance Physicians) AQuMed Executive Guideline Appraisal Groups Expert 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 GMA NASHIP Nat. Hosp. Ass. Statut. Sickn.F. Priv. Insuran.F. Publ.Pension Insur.Funds PIC Steering Group GMA NASHIP Disabled People Ass. Health Care Consum. Ass. Self Help Gr.A. Task Force Patient Safety – Error Prevention Programme Management Research and Development Training, Education Communication, Information Journ. for CME, Qual.Ass. ZaeFQ Website www.aezq.de

10. www.azq.de 10

11. www.azq.de 11 Quality problems in Germany ? Where is the evidence ?

12. www.azq.de 12 Problems with the German Healthcare System ? Deficits in quality, economic efficiency, transparency and patient orientation.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 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

13. www.azq.de 13 Outcomes in German Health Care Busse 2002

14. www.azq.de 14 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 Aiken et al, 2001 Busse 2002

15. www.azq.de 15 Source: WHO 2000 Total Expenditures on Health Total Expenditures on Health - % of GDP - Increasing contribution rates 13,5% to 14,5% (2002)

16. www.azq.de 16 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

17. www.azq.de 17 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

18. www.azq.de Feedback NICE Assessment Identification Appraisal & Guidance Appraisal & Guidance DisseminationDissemination Implementation Monitoring Evidence-Based Practice in Healthcare NICE – A New Model for Germany ? Littlejohns, NICE

19. www.azq.de 19 Littlejohns, NICE What about Professional Self-regulation ???

20. www.azq.de 20 Implementation of systematic Quality oriented + Evidence based Healthcare in Germany (by Self Governing Partners) Perleth & Schwartz 2001, modified „Orientation“ Phase Analysis of the international state of the art „Development“ Phase Development of methodological standards, networking (international/ national) „Evaluation“ Phase Testing, assessment of tools / procedures „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 1996200119971998199920002002

21. www.azq.de 21 Thanks for your patience !!!! www.azq.de www.leitlinien.de www.patienten-information.de www.g-i-n.net Founder Member