Sascha Wolf

Integrierte Versorgung – Vom Hoffnungsträger zum Ladenhüter der deutschen Gesundheitspolitik?

Dr. Sascha Wolf, Geschäftsführer, Bundesverband Managed Care e. V. Das deutsche Gesundheitswesen befindet sich in keiner Krise: Die medizinische Versorgung gehört immer noch zu den besten der Welt. Nicht Revolution, sondern Evolution lautet daher das Gebot der Stunde. Der entscheidende Treiber für notwendige Strukturveränderungen ist weder die Politik noch sind es die Akteure des Gesundheitswesens, sondern es sind die Versorgungsherausforderungen selbst, die einen kontinuierlichen Prozess hin zu integrierten und kooperativen Modellen erzwingen. Aufgabe der Politik ist es, den Akteuren ausreichende Handlungsmöglichkeiten zu geben, Anreize für Investitionen zu setzen sowie die Rahmenbedingungen schrittweise nachzubessern.

Totgesagte leben länger

The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germanys statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germanys SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germanys SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal governments innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.

Gesundheitssystem im Umbruch

The German health care system is faced with enormous challenges: population ageing, more chronic diseases and multimorbidity. The fragmentation of medical care into disconnected parts-ambulant and clinical services, pharmaceutical provision, nursing care etc.-is inefficient and inhibits coordinated courses of treatment. Instead of this new types of organizational structures and processes are needed. By means of different health care acts the German government has supported innovative medical care structures for many years. In the meantime, 30,000 doctors have joined 400 physician networks. Their aims are to improve the coordination of services, to facilitate collaboration among providers and to ensure better health care to the population. Furthermore, those interdisciplinary networks are crucial prerequisites for integrated health care. But there is still a lot of work to do. The successful integration of the components of health care into functioning process chains depends on political, economic and sociocultural parameters.

[Declared dead? Recommendations regarding integrated care from the perspective of German statutory health insurance].

The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germanys statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germanys SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germanys SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal governments innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.

Totgesagte leben länger@@@Declared dead?: Empfehlungen zur Integrierten Versorgung aus Sicht der gesetzlichen Krankenkassen@@@Recommendations regarding integrated care from the perspective of German statutory health insurance

The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germanys statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germanys SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germanys SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal governments innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.