Das Gesundheitswesen
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Das Gesundheitswesen · Apr 1997
[Health promotion by the public health service--problem areas and perspectives].
For more than ten years policy makers and researchers in the field of health policy have been requesting the local health departments in Germany to focus primarily on population-oriented and structural strategies in health promotion. Based on empirical findings of a study carried out in Berlin, this article argues that several structural and organizational factors in practice influence the implementation of these strategies by the local health departments. ⋯ More than ever, the definition of their tasks and targets needs to be linked to questions of organizational change and personnel. Moreover, the local health departments should define their role more clearly in relation to the other institutions in the sector of public health and in relation to the citizens.
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Das Gesundheitswesen · Apr 1997
[Misuse of inpatient care--background, indicators and evaluation parameters].
17a of the German hospital financing law constitutes the basis for the evaluation of not justified hospital admission. It demands not to admit patients into hospital who do not need inpatient treatment or, treat them in an inpatient-setting longer than medical required. Unjustified inpatient treatment results from faulty decision with regard to admission, to adequate intensity of medical care or duration of stay. ⋯ Testing parameters are, among others, occasion of admission, severity of illness, indication for complete in-patient treatment, utilisation of alternatives to medical care (outpatient, pre-, post-, partial inpatient treatment), adequacy of diagnostic or therapeutic intervention with regard to the disease, intensity, respectively chronological sequence of medical procedures, efficiency of organizational processes, transfer or discharge in time. The evaluation of unjustified admission to inpatient treatment should be conducted with a systematic approach including standardised methods and an adequate sample size on the basis of the individual medical report. In 1995 an outline as to testing of unjustified hospital admission as already presented by Bundes-Arbeltsgemeinschaft der Medizinischen Dienste der Krankenversicherung.
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Das Gesundheitswesen · Apr 1997
[Reliability of expert assessment in disability evaluation within the scope of disability insurance].
With the introduction of the law on the statutory nursing care insurance in Germany ("Pflegeversicherung") in 1995, new benefits are provided for the most severely disabled people. Provision of benefits is contingent on a standardised examination performed by the medical service of the German statutory health insurance system (MDK). Results of the first study on the inter-rater reliability of this standardised examination are presented in this paper. ⋯ Between the 2 rater groups there was no substantial difference in reliability. However, there was a trend for higher agreement within the group of nurses. Although the overall reliability of the assessment of disability is relatively high in comparison to many other diagnostic procedures (such as x-ray readings), efforts should be made towards further improvement of this standardised examination.