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Information on press releases and related news of the department "Health, Long‐Term Care and Pensions".

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Cover Arzneimittelreport 2015Cover Arzneimittelreport 2015
First analysis of expenditure on cytostatic drugs in statutory health insurance.

For the fifteenth time, the team of authors around Gerd Glaeske and Christel Schicktanz published the BARMER GEK Pharmaceutical Report 2015. By analysing the representative secondary data of prescriptions, expenditures and regional distributions of 8.6 million BARMER GEK insured, the pharmaceutical provision has been depicted convincingly. Special attention was drawn to the areas of supply where there is potential for improvement, i.e. drugs with unnecessary risks, preparations that are too frequently or too seldom prescribed as well as drugs with unnecessary costs.

Download:
BARMER GEK Arzneimittelreport 2015
Power Point Presentation at the press conference by Prof. Glaeske


Contact:
Prof. Dr. Gerd Glaeske
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58559
E-Mail: gglaeske@uni-bremen.de

Cover Pflegereport 2015 (Report on long-term care in Germany)Cover Pflegereport 2015 (Report on long-term care in Germany)
Team of authors from SOCIUM present report on long-term care in Germany on behalf of BARMER GEK.

The analysis of home care is the special focus of this year's BARMER GEK Long-Term Care Report (Pflegereport 2015), which was presented on 17th November 2015 at the Federal Press Conference. This is the eighth Long-term Care Report drawn up by a team of authors headed by Professor Heinz Rothgang at SOCIUM, University of Bremen. In addition to the special focus topic, the authors - Thomas Kalwitzki, Rolf Müller, Rebecca Runte and Rainer Unger - also examine key developments in long-term care. The study draws on official statistics comprising about 2.6 m. people in need of long-term care (LTC), the German Socio-Economic Panel (SOEP) and routine data provided by the BARMER GEK, whose membership comprises around ten per cent of the population, as well as questionnaires from a total of 1,850 respondents.

Very few allowances claimed for home alterations, though homes of 50% of people in need of care are not barrier-free

The homes of more than half of all beneficiaries of long-term care insurance (LTCI) in Germany living at home are not barrier-free. One would therefore expect more extensive use to be made of LTCI home alteration allowances - which can amount to up to €4,000 per case - to enable people in need of LTC to stay at home as long as possible; all the more so when one considers that over 97 % of questionnaire respondents who received allowances state that this money was extremely helpful. In fact, only about 3.5 % per year of care receivers living at home (65,000) took advantage of this allowance. The six home alterations carried out most frequently were (in descending order): level-access showers, stairlifts, handrails, toilet adaptations, hand grips, ramps.

There are two main reasons why so few people apply for home alteration allowances. The first is that 72 % of the respondents had to make co-payments, which may certainly have been a deterrent for many. On 1st January 2015 the allowance was increased from €2,557 to €4,000, reducing the amount of money applicants have to pay themselves. If the increase had taken effect in 2014, only half of applicants would have had to make co-payments. The second reason is that information about the allowances is not sufficiently communicated. Only half of the respondents received the relevant information from their insurance funds, the Medical Review Board, LTC providers or care support centres (Pflegestützpunkte). About one third of respondents who did not apply stated that they had no knowledge of such allowances. Almost half of the respondents who paid for alterations out of their own pocket did not know that care insurance allowances existed. Clearly there is an information deficit in this respect.

Second Act to Strengthen Long-term Care (PSG II) - a very generous reform

The central improvement brought about by the PSG II is the new definition of entitlement to long-term care benefits. The Act is unexpectedly generous in many respects. Firstly, the new assessment procedure comprises amendments that mean more people will be eligible for care and at the same time more people will qualify for a higher care category. Secondly, of the three proposals made by the Advisory Board for the transition of people already eligible for LTC from (the old) care levels to (the new) care grades, the most generous proposal was selected. Thirdly, the benefit amounts for the new care grades have been laid down in such a way that the benefits that had expressly been defined as transitional under the Long-Term Care Redirection Act (Pflege-Neuausrichtungsgesetz) have now been made permanent - not just for persons with limited daily living skills, i.e. mostly people with dementia, but for all persons in need of LTC.

Last but not least, comprehensive provisions have been made to safeguard existing amounts of benefits. As a result, more than 95 % of those receiving care at home on the date the new legislation came into force are better off, and none are worse off. In the long run, there are only very few people who will on balance be worse off under the new system than under the old one.

Number of people in need of care growing at a faster rate than anticipated; more men in need of care than women; increase in the number of very elderly people in need of care

On the basis of the 2011 census and the recent 13th Federal Statistical Office's Coordinated Population Projection, the number of people in need of LTC by the year 2060 (2055) will have grown to 4.52 m. (4.64 m.), i.e. 221,000 (164,000) more than in earlier projections. Of the additional cases, it is assumed that 176,000 will be men and 'only' 45,000 will be women. From 2040 on a dramatic increase in the number of very elderly people in need of LTC is expected. While in 2015 around 30 % of men in need of LTC were 85 years and older, this figure will increase to around 60 % by the year 2060. There will also be a significant increase in the number of very elderly women. While in 2015 around 50 % of women in need of long-term care are aged 85 and over, this figure is expected to rise to nearly 70 % by 2060. One of the dominant issues of the future will thus be the long-term care of the very elderly and the provision of adequate care structures.


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Cover Innovationsreport 2015Cover Innovationsreport 2015
Traffic Light Rating and Prescription of Newly Registered Drugs.

This is the third publication of the Innovation Report. Edited by Gerd Glaeske, Petra Thürmann and Wolf-Dieter Ludwig, the Innovation Report provides the first data on prescriptions of new drugs – which distinguishes it from all other reports on pharmaceutical products. These drugs, which have undergone the AMNOG early evaluation process, are subjected to a review which also includes everyday medical treatment. Both the prescribed amounts and expenditure are considered and set in relation to the benefit of these medicines in their respective indications.

Gerd Glaeske (SOCIUM, University of Bremen), Wolf-Dieter Ludwig (HELIOS-Klinikum Berlin-Buch and Chair of the Drug Commission of the German Medical Association) and Jens Baas (Chair of the Board of the Techniker Krankenkasse health fund) presented the Innovation Report 2015 on September 9th, 2015 in Berlin. The report was drawn up, with the kind support of the Techniker Krankenkasse, by a team of authors comprising Daniela Boeschen, Dörte Fuchs, Dr. Judith Günther and Prof. Dr. Gerd Glaeske from the Health Care Research Division of the Department of Health, Long-Term Care and Pensions at SOCIUM (formerly ZeS), University of Bremen. The report evaluates evidence on and the efficacy of new medicines that came onto the market in 2012 and considers their prescriptions in the years 2012 and 2013 in the light of routine data from the Techniker Krankenkasse.

Download: Innovationsreport, Long Version, in German


Contact:
Prof. Dr. Gerd Glaeske
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58559
E-Mail: gglaeske@uni-bremen.de

Patient oriented outcome research - yesterday, today, tomorrow.

Health services research has achieved a lot in the meantime - but is it enough? The Advisory Council on Health claimed in its report of 2000/2001 an expansion of outcome research and an increased use of administrative data. This includes primarily the presentation of rational and quality-oriented patient care through methodologically adequate studies, the revealing of overuse, underuse and misuse of care and an evaluation of health policy-induced changes in our health care system. These aspects still determine future challenges for health services research on a medical, political and economic level:

  • more comprehensive evaluation concepts of therapeutic measures in favor of patients and from the perspective of patients on the basis of adequate funding;

  • development of new concepts to improve care structures and processes;

  • improved transfer of research results for the public and increased consideration of the findings in politics.

The congress focuses on outcome research by taking into account already achieved results and future requirements for improvement opportunities regarding the quality of care.

Contact:
Dr. Christoph Straub
CEO of Barmer GEK


Contact:
Prof. Dr. Gerd Glaeske
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58559
E-Mail: gglaeske@uni-bremen.de

Dipl.-Soz. Friederike Höfel
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58520
E-Mail: fhoefel@uni-bremen.de

Cornelia Trittin
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58560
E-Mail: cornelia.trittin@uni-bremen.de

Scientists at the University of Bremen examine quality of care in 50 inpatient facilities and carry out a survey on 2000 residents

Do nursing home residents stay mobile for as long as possible? Do they maintain their independence when carrying out routine everyday tasks and are the care services provided in keeping with the latest standards of knowledge? A research team at the University of Bremen has set out to investigate the measurability of the quality of resident care facilities on the basis of these and further questions. Principal investigators are Prof. Dr. Stefan Görres of the UBC Centre for Gerontology and Long-Term Care Research and Prof. Dr. Heinz Rothgang of the UBC Centre for Social Policy Research. The team responded to a call for tenders issued by the Federal Association of Statutory Heath Insurance Funds (GKV-Spitzenverband), which is coordinating the project. Over a period of 18 months, it will collect and analyse data from 50 care facilities in the federal states of Brandenburg und Baden-Wuerttemberg with a view to facilitating a consumer-friendly comparability of care quality. The contract principals are the contracting parties of the German Social Welfare Code, namely the Federal Association of Statutory Heath Insurance Funds (GKV-Spitzenverband) and federal welfare and residential long-term care associations.

Aspects of quality that have never been assessed until now

The aim of the project is to pilot test 15 care-related indicators, which were first developed by Dr. Klaus Wingenfeld from Bielefeld University and Dr. Dietrich Engels of the ISG Institute for Social Research and Health Policy, on behalf of the Federal Ministry of Health and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth. To this end, data will be collected from approximately 2,000 nursing home residents. “What is crucial is quality, that is, what [services] do elderly people actually receive, what is their health status, and how do they feel?” explained care expert Professor Görres. “Until now this has almost never been assessed; the focus of quality investigations was only on structures and processes in inpatient facilities.”

Priority issues for Bremen Long-Term Care Researchers

According to project coordinator Mathias Fünfstück, pressure sores (decubitus ulcers) are one of the chief indicators of insufficient mobility. Can sores in nursing home residents be prevented? Other questions include serious falls, weight loss, and pain. “We will be working closely with selected professional carers in every inpatient facility,” he explains. In order to coordinate the documentation special software will have to be developed. “The software must be tested for practicability, comprehensiveness and precision”, says Professor Görres. “It may be necessary to make adjustments or modifications.” What is crucial here is that the nursing homes are not blamed for things they cannot do anything about. “If one residence has more bed-bound patients than others then that must be taken into account when the figures for residents with pressure sores are compared,” says Professor Rothgang. “The rules for risk adjustment are still incomplete and will be developed and substantiated in the course of the project.” Ultimately, the outcome should be a field-tested quality measurement tool. This is the third study of major societal and political significance with which the experts from the University of Bremen have been entrusted within a short period of time, and that alone can be seen as a great achievement. As Görres explains, “We are working almost in parallel on a project concerned with mobility in old age.” A further project, which provided the basis for the introduction of the new definition of the need for care, was concluded by Rothgang and Fünfstück a few months ago.

Contact:
Prof. Dr. Stefan Görres
Phone: +49 421 218-68901
E-Mail: sgoerres@uni-bremen.de


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Mathias Fünfstück
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58637
E-Mail: fuenfstueck.mathias@uni-bremen.de

In summer 2014 Rolf Müller and Heinz Rothgang were commissioned by the Senator for Labour, Women's Affairs, Health, Youth and Social Affairs in Bremen, to drawn up a report on Requirements and Supply for Traineeships in Long-Term Care.

The results out of the report on "Requirements, Supply and Prognosis for Traineeships in Long-Term Care" were presented to the Bremen State Committee on Long-Term Care on January 16th, 2015.

The report was commissioned owing to concerns that there is not enough training in long-term care. The objective was to consider the merits of a compensation mechanism for funding long-term care training in Bremen in order to avoid a shortage of skilled carers. Should such a measure be deemed necessary in order to forestall a shortage of trainee placements, the Bremen state government is empowered to impose a charge on care facilities to compensate for the cost of training allowances. In order to determine whether the demand for long-term care training can be met at the present moment and for the period until 2025, requirements and availability for the period 2014-2025 needed to be calculated.

This new report provides reliable figures and data. At present, and up until 2025, around 300-400 trainee places will be needed each year for the qualification of long-term care workers within the city state of Bremen. In 2014, however, there were well under 200 trainees in each year of training. On the basis of currently realistic assumptions, this gap will remain constant over the next 10 years. Under more favourable conditions (significantly higher growth rates and significantly reduced drop-out rates in training as well as significantly longer periods of employment in that occupation), it should be possible to reach the required number of traineeships by 2025. Before then, however, there will be a serious shortage of qualified long-term carers. In the light of current demographic trends urgent measures are required, as on the one hand there is a noticeable increase in the need for care, while on the other the potential number of available employees is expected to drop.


Contact:
Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Cover BARMER GEK Care Report 2014Cover BARMER GEK Care Report 2014
This year’s report looks at the provision of dental treatment for people in need of care.

The focus of the 7th edition of the BARMER GEK Care Report is the provision of dental check-ups and treatment to people in need of long-term care (LTC). The report presents a broad overview of dental care provision for LTC receivers, describes the problems identified, outlines the most recent legislative changes in response to these problems and points to further potential for improvement.

The research team at the Centre for Social Policy Research (ZeS), including Professor Heinz Rothgang, Rolf Müller, Rebecca Mundhenk and Rainer Unger, also examines the provision of LTC in general and discusses major developments in LTC insurance. The primary database for the Report are data for all 2.6 m. people in need of long-term care collected by the Federal Statistical Office and claims data of all BARMER GEK insurees, who make up approx. 10 per cent of the population of Germany. The results will be presented today at the Federal Press Conference Building in Berlin. 


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. Rainer Unger
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58553
E-Mail: rainer.unger@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

ProHealth 65+ Health promotion and prevention of risk - action for seniors.

The newly launched project ProHealth 65+, focused on health promotion and prevention of health risks among seniors, held its kick-off meeting on 3-4 November in Luxemburg. The project seeks to determine effective methods of promoting a healthy lifestyle among older population groups by bringing together knowledge and experience of main partners and health promoters from Poland, Germany, Italy and the Netherlands and exchange it with collaborating partners: Portugal, Greece, Bulgaria, Czech and Hungary. The effective implementation of training for health promoters working with this age group is the ultimate project goal. The Centre for Social Policy Research – represented by Heinz Rothgang and Kai Huter –  is the German project partner.

Additional Information:
News on the Chafea-Website


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

BARMER GEK Heil- und Hilfsmittelreport 2014BARMER GEK Heil- und Hilfsmittelreport 2014
Produced by members of the ZeS, the BARMER GEK Heil- und Hilfsmittelreport investigates the German statutory health care in a ten year tradition.

The BARMER GEK Heil- und Hilfsmittelreport 2014 reports the amount of prescriptions and expenditures from 2013 and 2012: Expenditures for therapeutic interventions reached 774 million Euro (+5.6 %). For medical devices 867 million Euro (+10.2 %) were spent. While rates of increasing numbers of insurants who were treated with these therapeutics were considerably lower than the increase of expenditures, the growth of treatment costs is shown. Especially the increasing costs for medical devices highlight the importance of their market, which is becoming progressively more lucrative to producers and suppliers. Unlike with current procedures in the pharmaceutical market, where drugs have to be approved before application, the vast majority of medical devices require a self-declaration by the manufacturer in order to receive the CE-marking for marketing in the European market. There are no requirements for the demonstration of a long term patient benefit – an unacceptable situation. Besides claiming for a substantial benefit and cost-benefit assessment, the report provides detailed proposals for further activities for better quality and transparency of care with medical devices in the statutory health care system.

The diagnosis related analyses assess important subjects of an older growing society with a high burden of chronic diseases, among others, considering regional aspects: Since the results show that only 40 percent of people with chronic wounds received a compression therapy and 75 percent of diabetic patients with a high risk for food complications did not receive podiatric treatment, a clear under-treatment was identified. Further analyses provide transparency of the utilization of blood glucose test strips, which was characterized by regional differences.

Download:
BARMER GEK Heil- und Hilfsmittelreport 2014, only available in German
Supplementals, only available in German


Contact:
Prof. Dr. Gerd Glaeske
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58559
E-Mail: gglaeske@uni-bremen.de

Bestandsmarktreport 2014Bestandsmarktreport 2014
The Centre for Social Policy Research (ZeS) at the University of Bremen continues the cost-benefit assessment of drugs with existing admission to the pharmaceuticals market.

Since 2011, the Pharmaceuticals Market Reorganization Act (AMNOG) stipulates an early assessment for newly approved drugs if they are to be prescribed within the statutory health insurance (SHI). This cost-benefit assessment has consequences for the drug prices in the SHI Pharmaceuticals Market. The original intention was to subject important and often prescribed pharmaceuticals of the existing drug market to an AMNOG efficiency rating as well. This law, however, was changed on April 1, 2014, the examination of the already registered drugs was abolished. Medicines, which, compared to proven and affordable treatment alternatives, do not have recognized additional benefits, continue to cause unnecessary costs for the SHI in the billions.

The Centre for Social Policy Research (ZeS) has continued the review process for certain drug groups with the kind support of the TK, a German health insurance fund. The German Federal Joint Committee, the G-BA, had commenced this process before the abolition of the law with a few medicines of the existing pharmaceuticals market.
The market development of selected drug groups was illustrated by routine data of the TK health insurance fund. The focuses of the review are new oral anticoagulants, newer antidiabetic drugs (GLP-1 agonists and DPP-4 inhibitors) and drugs for the treatment of rheumatoid arthritis.

The evaluated 17 drugs were assessed on the basis of a literature review in relation to their patient-oriented additional advantage, compared to established drug therapy options. None of the drugs was evaluated positively in the overall assessment. For example, none of the six studied antidiabetic obtained an additional asset. Of the products still in the market (two antidiabetic agents were withdrawn from the market because the manufacturers could not implement their price expectations) only two (still more expensive than comparative therapies or agents of first choice) were cheaper in relation to drugs from the same drug class.

Overall, our results highlighted the need for the AMNOG rating of the existing pharmaceuticals market to improve the efficiency of the drug supply. The results of this report will therefore be placed at the disposal of prescribing physicians.

Download: Bestandsmarktreport 2014, in German


Contact:
Prof. Dr. Gerd Glaeske
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58559
E-Mail: gglaeske@uni-bremen.de

Dipl.-Soz. Friederike Höfel
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58520
E-Mail: fhoefel@uni-bremen.de