Integrated care (Integrierte Versorgung; IGV)The term "Integrierte Versorgung (IGV)" denotes the interconnectedness of separate sectors of health care. To illustrate: general practitioners and specialists in own practice cooperate with stationary facilities, act jointly in treating their patients, and share a budget where required. So far, integrated care has not been a form of medical care to loom large in the German health care system. Up to now, ambulant (surgery) and stationary (hospital) care are seperated in the German health care system. For example, this affects competences, responsibility, and payment as well. |
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Negotiations on integrated care between health insurance companies, physicians and hospitals collapsed time and again with matters of financing in the past. Since there was no extra-budget for such treaties, it was indistinct from what source - hospital's budget or physician's salary - which amount should be branched off. The law for modernization of the compulsory health insurance fund (Gesetz zur Modernisierung der gesetzlichen Krankenversicherung; GMG), which has become operative on january, 1st in 2004, furthered new treaties for integrated care. Up to one percent of the annual medical salary (about 220 million euros) and one percent of the hospital's budget (roughly 460 million euros) are prepositioned especially for integrated care. With a change in the law concerning the regulatory framework for practicing as a statutory health insurance physician (Vertragsarztrechtsänderungsgesetz VÄndG), the start-up financing has meanwhile been extended to the end of 2008.
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IGV-Networks
Networks to be ministered are limited regionally and refer to clearly defined indications. In detail, it is about the following networks (level of information: july 2006):
- cardiological care Essen
- vascular medicine Krefeld
- hernia surgery Cologne
- prostate CA Mönchengladbach, Neuss, Leverkusen
- osteoporosis Aachen
- ambulant tumor center Essen
- apoplexia Krefeld
- intestine center Duisburg-Süd
- depressions Aachen
- diabetical foot Düsseldorf
- diabetical foot Cologne/Leverkusen
- ovarial CA Bonn, Düsseldorf, Krefeld, Leverkusen
- trauma management Essen Nord-Süd
- trauma management Essen Ost-Mitte
- multiple sklerosis Rheinland
- endo-prosthetics Eifel-Erft
- addicts Bonn
- prostate CA Rhein-Ruhr
- prostate CA Cologne
- apoplexia Cologne
- apoplexia Bonn-Rhein-Sieg
- headache Essen
- further networks in planning
Numerous of the listed networks shall, as far as possible, be compared with a control group from regular medical treatment to testify their efficacy. To generate medically homogenous comparison groups it is necessary to relate each registered patient to a patient in regular medical treatment with a matchable morbidity.
Aims in quality and costs
The following main focuses were placed for quality objectives in the IGV Rheinland:
- structural quality:
conditions under which practicing takes place (general conditions, poltical and economic factors, technical equipment in a surgery, abilities of personnel, accuracy of data documentation, physician's level of training) - process quality:
statements about medical activities taking into consideration interpersonal and interactional aspects (modalities in cross-sector cooperation of suppliers) - result quality:
anticipated changes in a patient's or population group's state of health as a result of defineable therapeutic or diagnostic measures/interventions within health care sequences
In placing the expense objectives, not the originator but the agent, who is to bear the costs, is in the center of interest. The following focuses were set:
- costs relating to treatment:
all expenses that are balanced by the health insurance companies within the treatment of a patient. - costs relating to patients:
all expenses that the patient has to pay in connection with his disease in addition to the costs refunded. - costs relating to the employer:
all expenses that arise from the disease for the employer/the self-employed apart from insurance payments.
Tasks for MNC
- advancement of the evaluation/controlling concept
- analysis of qualitative and quantitative aims defined for the respective network, and further generation of therefore required queries and analysis programs
- further analyses on demand of the client
- constant processing and delivery of reports in due time (quarterly)
- delegation of a member of staff for IT-coordination
All collected quality data (questionnaires to be filled in by patients), costs, and performance characteristics (billing data following SGB 5) of patients registered in respective networks are taken into account for the evaluation report, in which the target achievement is made transparent with the help of tables and graphics.
Do you have any questions concerning integrated care? Contact us via the contact blank or call us!
- head of project: Dr. Christof Münscher
- authors: Alexandra Berendes, Dr. Christof Münscher
- programming: Alexandra Berendes, Wolfgang Weber