Stephanie Stock

The evolution of health literacy assessment tools: a systematic review

BackgroundHealth literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument.MethodsWe performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE.ResultsWe identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline.ConclusionsScholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear “consensus” on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.

Diabetes—prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany

Objective  This population‐based study assesses the prevalence and cost of illness as a result of diabetes mellitus in Germany by retrospectively analysing routine health insurance data. Prevalence and costs were analysed from statutory health insurance (GKV) and societal perspectives.

Reflections on the changing face of German pharmaceutical policy: how far is Germany from value-based pricing?

Statutory health insurance (SHI) in Germany serves 90% of the population. Predicted SHI deficits for 2010 and 2011, of h7 billion and h10–12 billion, respectively, resulted in a law freezing the prices of drugs already in the market (which came into effect on 1 August 2010). The subsequent ‘Act to Reorganize the Pharmaceuticals’ Market in the SHI System’ (Gesetz zur Neuordnung des Arzneimittelmarktes in der gesetzlichen Krankenversicherung [AMNOG]) passed through Federal Parliament on 11 November 2010 and came into effect on 1 January 2011. What implications does this have for the health economic evaluation of new drugs in Germany? We delineate where and how health economic evaluation will be tied in with decision making on drug prices, and also explore how close the new law will come to value-based pricing, a question verymuch in discussion in other healthcare systems.

Financial incentives in the German statutory health insurance: new findings, new questions

OBJECTIVES This paper presents findings of a mandatory three-year evaluation of a prevention bonus scheme offered in the German Statutory Health Insurance (SHI). Its objective is to describe the rationale behind the programs, analyze their financial impact and discuss their implications on potentially conflicting goals on solidarity and competition. METHODS The analysis included 70,429 insured enrolled in a prevention bonus program in a cohort study. The intervention group and their matched controls were followed for a three-year period. Matching was performed as nearest neighbor matching. The economic analysis comprised all costs relevant for Sickness Funds (SF) in the SHI and was carried out from a SHI perspective. Differences in cost trends between the intervention and the control group were examined applying the paired t-test. RESULTS Regarding mean costs there was a significant difference between the two groups of euro177.48 (90% CI [euro149.73; euro205.24]) in favor of the intervention group. If program costs were considered cost reductions of euro100.88 (90% CI [euro73.12; euro128.63]) were obtained. CONCLUSIONS The uptake of a prevention bonus program led to cost reductions in the intervention group compared to the control group even when program costs were considered. However, the results must be interpreted with caution as in addition to financial aspects, socio-economic and health-status, selection bias and the function and use of bonus programs as marketing tools, as well as their long-term sustainability should be considered in future assessments.

Cost-effectiveness analysis of FET PET-guided target selection for the diagnosis of gliomas.

PurposeSeveral diagnostic trials have indicated that the combined use of 18F-fluoroethyl-l-tyrosine (FET) PET and MRI may be superior to MRI alone in selecting the biopsy site for the diagnosis of gliomas. We estimated the cost-effectiveness of the use of amino acid PET compared to MRI alone from the perspective of the German statutory health insurance.MethodsTo evaluate the incremental cost-effectiveness of the use of amino acid PET, a decision tree model was built. The effectiveness of FET PET was determined by the probability of a correct diagnosis. Costs were estimated for a baseline scenario and for a more expensive scenario in which disease severity was considered. The robustness of the results was tested using deterministic and probabilistic sensitivity analyses.ResultsThe combined use of PET and MRI resulted in an increase of 18.5% in the likelihood of a correct diagnosis. The incremental cost-effectiveness ratio for one additional correct diagnosis using FET PET was €6,405 for the baseline scenario and €9,114 for the scenario based on higher disease severity. The probabilistic sensitivity analysis confirmed the robustness of the results.ConclusionThe model indicates that the use of amino acid PET may be cost-effective in patients with glioma. As a result of several limitations in the data used for the model, further studies are needed to confirm the results.

Sex Differences in Treatment Patterns of Six Chronic Diseases: An Analysis from the German Statutory Health Insurance

OBJECTIVE The goal of this study was to investigate gender-specific differences in prevalence, healthcare costs, and treatment patterns in the German Statutory Health Insurance (SHI). METHODS The study analyzed administrative claims data of over 26 million insured with respect to prevalence and cost of illness of six chronic diseases. Insured were identified using the ATC code for medication prescription and ICD-9 code for diagnosis. The influences of gender, age, and comorbidity on cost differences were analyzed via multivariate regression analysis. RESULTS Adjusted for age and comorbidity, gender had a significant influence on both hospital and medication spending. Hospital costs on average were 17.1% (95% CI 14.1; 20.2) higher for men compared with women. Medication spending for men exceeded that for women on average by 13.8% (95% CI 10.9; 16.7). The diagnoses with the highest prevalence were hypertension and heart failure. Women had a higher prevalence of diabetes, coronary artery disease (CAD), heart failure, and hypertension. Medication costs were higher for men in three of five diagnoses and comparable for two diagnoses (diabetes and asthma). Women received more medication prescriptions than men, but on average prescriptions for men were 14%-26% more expensive than prescriptions for women. Regarding treatment patterns men were treated with different drug classes in cardiovascular disease (CVD) compared with women. Total medication spending stratified by diagnosis was highest for diabetes. CONCLUSIONS Gender differences for costs and prescribing patterns for chronic diseases vary disease specifically, but generally men had higher inpatient costs and more expensive medication prescriptions, whereas women had higher numbers of prescriptions.

Is prevention of atopic eczema with hydrolyzed formulas cost‐effective? A health economic evaluation from Germany

To cite this article: Mertens J, Stock S, Lüngen M, Berg AV, Krämer U, Filipiak‐Pittroff B, Heinrich J, Koletzko S, Grübl A, Wichmann H‐E, Bauer C‐P, Reinhardt D, Berdel D, Gerber A. Is Prevention of Atopic Eczema with Hydrolyzed Formulas Cost‐Effective? A Health Economic Evaluation from Germany. Pediatr Allergy Immunol 2012: 23: 597–604.

Preliminary analysis of short term financial implications of a prevention bonus program: First results from the German statutory health insurance

SummaryObjectives:With the implementation of the Health Care Modernization Act in 2004 sickness funds in Germany were given the opportunity to award bonuses to their insured for healthpromoting behavior. The aim of this study was to investigate the financial implications of a prevention bonus program from a sickness fund perspective.Method:The investigation was designed as a controlled cohort study (matched pair study) comprising 70,429 members in each group. Matching criteria were sex, postal code, insurance status, and cost categories for health care utilization. Insured opted into the program on a voluntary basis. The program consisted of interventions featuring primary prevention, modest exercise and immunization. Differences in cost trends between the two groups were examined using the paired t-test.Results:A reduction in mean costs of 241.11 € per active member for the year 2005 (90 % CI = 348.70, 133.52; p-value < 0.001) could be achieved in the intervention group compared to the control group. When costs for the implementation of the program and the bonus payments were taken into account, there was a saving of 97.14 € per active member for the year 2005.Conclusions:Preliminary results of a prevention bonus program in the German Statutory Health Insurance suggest a decrease in mean health care spending per enrollee. These effects may increase with time as long term effects of prevention become effective. However, further research is needed to understand how much of these short term cost reductions can be attributed to the program itself rather than to possible confounders or volunteer bias and how the short term savings may be accrued.

Patients with Type 2 Diabetes Benefit from Primary Care-Based Disease Management: A Propensity Score Matched Survival Time Analysis

This study aimed to assess the impact of a nationwide German diabetes mellitus disease management program (DMP) on survival time and costs in comparison to routine care. The authors conducted a retrospective observational cohort study using routine administration data from Germanys largest sickness fund to identify insured suffering from diabetes in 2002. A total of 95,443 insured with type 2 diabetes mellitus who were born before January 1, 1962 met the defined inclusion criteria, resulting in 19,888 pairs of DMP participants and nonparticipants matched for socioeconomic and health status using propensity score matching methods. This is the first time propensity score matching has been used to evaluate a survival benefit of DMPs. In the time frame analyzed (3 years), mean survival time for the DMP group was 1045 days vs. 985 days for the routine care group (P<0.001). Mean daily hospital and total costs (including DMP administration and medical costs) were lower for the DMP group in the case of deceased insureds (92€ vs. 139€ and 122€ vs. 169€, respectively) as well as for censored observations (6€ vs. 7€ and 12.9€ vs. 13.4€, respectively). Mean daily drug costs were slightly lower for deceased insured in the DMP group (difference 0.6€), while no identifiable difference was found for censored observations. In this study, insured who were enrolled in a DMP for diabetes mellitus in the German Statutory Health Insurance showed a significant benefit in survival time. They also incurred lower costs compared to propensity score matched insured in routine care.

Gesundheit für alle

Das deutsche Gesundheitswesen steht vor grosen Herausforderungen. Hinter diesem lapidaren Satz verbergen sich grose Reformnotwendigkeiten, die tiefgreifende Einschnitte in die bestehenden Machtverhaltnisse und Strukturen erfordern. Trotz der in allen Bereichen der sozialen Sicherungssysteme andauernden Reformdebatten, werden die sozialen, demographischen und okonomischen Veranderungen der nachsten Jahrzehnte in ihren Auswirkungen auf die sozialen Sicherungssysteme haufig auf die Frage der Finanzierung reduziert. Unstrittig ist eine nachhaltige Finanzierung der sozialen Sicherungssysteme eine wichtige Basis fur die Zukunft des Sozialstaates. Ob sie erfolgreich gemeistert werden kann, hangt in hohem Mase davon ab, in wie weit zukunftige Reformen die Grundlage fur eine Verbesserung von Innovationskraft, Produktivitat und Chancengleichheit legen konnen. Der kunftige Wohlstand des Landes - und in der Folge die Zukunft der umlagefinanzierten Sozialsysteme - wird auch durch die Gesundheitspolitik mitentschieden werden. Menschen konnen nur dann Eigen-verantwortung ubernehmen und aktiv und ohne Einschrankung an den Moglichkeiten einer Gesellschaft teilnehmen, wenn sie gesundheitlich dazu in der Lage sind. Es ist die Aufgabe einer zukunftsorientierten Gesundheitspolitik daran mit zu wirken, dass durch eine moglichst hohe Chancengleichheit Potenziale aller Schichten der Gesellschaft fur eine hohere Innovationskraft und Produktivitat zur Verfugung stehen.