Das Gesundheitswesen
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Public Health is a social innovation of the modes how society deals with health risks before and after their occurrence. In this paper the essence of this innovation is sketched out with regard to the four stages of the Public Health Action Cycle (assessment, policy formulation, assurance, evaluation). Based on both literature surveys and own research findings several critical aspects of innovation are identified at each of these stages. At present, the bottle-neck of the intended social innovation seems to be the implementation, stabilisation, and generalisation of interventions.
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Das Gesundheitswesen · Feb 1995
[Frequency analysis for achieving health goals--I: Standardization].
The formal mathematical steps of direct and indirect standardisation are deduced and it is pointed out that standardisation is an analytical concept for processing data within the framework of structurised populations to enable correct interpretation of these data in a manner modified according to specific problems. In particular, this concept is not confined to transforming age-structured mortality data of a population to the age distribution of the members of a larger population by means of a rule of three. Standardisation is in fact a model of the macrolevel (population). ⋯ The standardisation approach can be used in case of weighted arithmetic, geometric or harmonic means. Before effecting standardisation, the type of connection between the employed data should be examined. The examples of concepts of direct standardisation refer to cardiovascular and accident mortality in West Berlin from 1963 to 1991, whereas those of indirect standardisation are based on the accident mortality in West Berlin in 1987 structured according to city districts.
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Das Gesundheitswesen · Nov 1994
[Trends in nursing care requirements in German 1990-2050--results of demographic projections].
Since the political agreement on the financing of elderly primary care, the question of the determinants for both the absolute number of elderly persons requiring care and the care burden is of particular importance. The probable demographic effects of a change in immigration and mortality rates in Germany are shown with the aid of various models. ⋯ Similarly, the future care burden will not remain stable with an increased immigration of young people; rather it will increase as well. It can thus be predicted that the problem of the care burden as well as its financing will remain an important topic in the future for demographic reasons alone.
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This article concerns the rules and regulations governing the Federal German compulsory (statutory) health insurance which, among other ordinances, define the tasks of a so-called "Medical Service of the Statutory Health Insurance". The definitions given under the heading "Expertizing and Consultation" create a field of tension between the activities of advising the insured patient on the one hand and giving an expert opinion to the insurance body on the other, both functions being exercised by one and the same doctor. ⋯ These case reports show that there is no contradiction between consulting and expertizing: the results of expertizing can be conveyed to the patient in a comprehensible manner only by advising the patient accordingly. The expertizing doctor is no longer anonymous when he gives advice to the patient, and this is a challenge--in respect of competence, human understanding, and ability to face and resolve conflicts.