Martin Emmert

Objetivo: determinar el impacto de gastos catastróficos por motivos de salud sobre la atención médica y gastos educativos privados en población no asalariada de México. Material y Métodos: estudio transversal. Durante 2010 se realizaron entrevistas cara a cara y semiestructuradas en familias no asalariadas de la ciudad de México. Resultados: se realizaron entrevistas en un total de 133 hogares (la edad promedio fue de 43.5 años y 60% fueron mujeres); 30% de los entrevistados mencionó que los tratamientos médicos que necesitaron debieron ser prematuramente terminados o nunca pudieron ser iniciados, debido a los elevados gastos que implicaban. A través de este método se pudo demostrar una relación negativa entre gastos catastróficos y gastos educativos privados en los hogares con gastos catastróficos (p<0.001). Conclusión: en la población de la ciudad de México los gastos catastróficos juegan un papel importante en la atención médica, consecuentemente, las políticas económicas en México deberían suministrar programas que cubran de manera suficiente los gastos de salud.

Determinar el impacto de gastos catastróficos por motivos de salud sobre la atención médica y gastos educativos privados en población no asalariada de México. estudio transversal. Durante 2010 se realizaron entrevistas cara a cara y semiestructuradas en familias no asalariadas de la ciudad de México. se realizaron entrevistas en un total de 133 hogares (la edad promedio fue de 43.5 años y 60% fueron mujeres); 30% de los entrevistados mencionó que los tratamientos médicos que necesitaron debieron ser prematuramente terminados o nunca pudieron ser iniciados, debido a los elevados gastos que implicaban. A través de este método se pudo demostrar una relación negativa entre gastos catastróficos y gastos educativos privados en los hogares con gastos catastróficos (p < 0.001). en la población de la ciudad de México los gastos catastróficos juegan un papel importante en la atención médica, consecuentemente, las políticas económicas en México deberían suministrar programas que cubran de manera suficiente los gastos de salud. to determine the impact of catastrophic expenses on account of health care and private educational expenses in self-employed population of Mexico. cross-sectional study. In 2010, face to face and semi-structured interviews were conducted in self-employed families of Mexico City. interviews were conducted in a total of 133 homes (the average age was 43.5 years and 60% were women); 30% of those mentioned that medical treatments needed could be prematurely terminated or could never be started, due to the high costs involved. A negative relationship between catastrophic expenses and private education expenses in households with catastrophic expenses (p < 0.001) could be demonstrated through this method. in the population of Mexico City catastrophic expenses play an important role in health care, as a result, economic policies in Mexico should provide programs that sufficiently cover health costs. determinar o impacto de gastos catastróficos sobre os cuidados de saúde e gastos com a educação privada em população não-assalariados no México. estudo transversal. Em 2010, foram realizadas entrevistas face-a-face e semi-estruradas em famílias não assalariadas na cidade do México. as entrevistas foram realizadas em um total de 133 lares (a média de idade foi de 43.5 anos e 60% eram mulheres); 30% dos entrevistados mencionaram que tratamento médico que eles precisaram teve de ser encerrado prematuramente ou não chegou a ser iniciado devido aos altos custos envolvidos. Através deste método, fomos capazes de demonstrar uma relação negativa entre gastos catastróficos e educacionais privados em domicílios com gastos catastróficos (p < 0.001). na população da cidade do México os gastos catastróficos desempenhar um papel importante no tratamento médico. Consequentemente, as políticas econômicas do México deveriam oferecer programas que atendam os custos dos cuidados de saúde necessários.

Physician Choice Making and Characteristics Associated With Using Physician-Rating Websites: Cross-Sectional Study

Zielsetzung: Die Zielsetzung der vorliegenden Untersuchung ist die Analyse des gegenwärtigen Standes von Bewertungen auf deutschsprachigen Arztbewertungsportalen (ABP) am Beispiel des Nürnberger Gesundheitsnetzes Qualität und Effizienz (QuE). Methodik: 1. Auswahl von 5 relevanten ABP im deutschsprachigen Internet. 2. Rohdatenerhebung für die 106 QuE-Ärzte bezüglich der vorhandenen Bewertungen auf den 5 ABP durch 2 Autoren der Studie unabhängig voneinander (Stichtag: 8.11.2012). 3. Deskriptive Analyse der vorhandenen Bewertungen anhand von 10 aus der international publizierten Literatur abgeleiteten Fragestellungen. 4. Diskussion der Ergebnisse mit national sowie international vergleichbaren Ergebnissen. Ergebnisse: Die Portale Arztauskunft, Imedo, Jameda, DocInsider sowie die Weisse Liste wurden berücksichtigt. 96 % der Ärzte des betrachteten Arzt-Samples sind auf den ABP gelistet. 50 % der Ärzte wurden bereits bewertet; eine große Differenz zwischen den ABP ist vorhanden (Min. 29 %, Max. 81 %). Der Anteil der Ärzte mit mindestens 5 bzw. 10 Bewertungen betrug 17 bzw. 9 %. Wir ermittelten 3,08 abgegebene Bewertungen pro Arzt (0,45 – 9,03; SD 3,71). Die Bewertungen sind überwiegend positiver Natur, 74 % sind in die jeweils beste und 5 % in die schlechteste Notenkategorie einzuordnen. Herabsetzende oder beleidigende Kommentare in Freitextfeldern wurden nicht gefunden; 86 % der Kommentare sind positiver Natur. Schlussfolgerung: Die Anzahl von Bewertungen auf deutschsprachigen ABP scheint zu wachsen. Sowohl die durchschnittliche Anzahl an Bewertungen je Arzt als auch der Anteil der Ärzteschaft mit einer größeren Anzahl an Bewertungen hat zugenommen. Die gezeigten Werte übersteigen solche aus den USA, wo ABP bereits länger etabliert sind. Die gezeigten Ergebnisse lassen allerdings keine verallgemeinernden Rückschlüsse zu. Objective: The objective of the present study was to investigate the current status of online physician evaluations on German PRWs. Therefore, we studied 106 physicians from the Integrated Healthcare Network “Quality and Efficiency”, located in Nuremberg, Bavaria. Methods: 1. Five relevant German PRWs were chosen. 2. Data was collected for the 106 physicians on the five PRWs. Two authors independently carried out the data collection (date of data collection 08/11/2012). 3. Descriptive analysis was conducted addressing ten literature-based issues. 4. Discussion of our results with national and international published results. Results: The following German PRWs were considered: Arztauskunft, Imedo, Jameda, DocInsider, and the Weisse Liste. It could be shown that 96 % of all physicians could be identified on the websites. On average, 50 % of all physicians were rated at least once. However, great differences between the websites could be detected (Min 29 %, Max 81 %). The percentage of physicians with at least 5 respectively 10 ratings was calculated to be 17 % respectively 9 %. A mean of 3.08 ratings per physicians could be counted (range 0.45 – 9.03, SD 3.71). Most ratings were positive; approximately 75 % could be assigned to the best rating category and only 5 % to the worst rating category. Mean length of narrative comments was 28 words, 86 % were favorable. We could not find any evidence of “doctor-bashing” or defamation. Conclusions: The number of online evaluations on German PRWs has been increasing. Both, the mean number of ratings as well as the percentage of rated physicians has further risen. The numbers determined exceed those from the US but, in general, are in line with respect to the nature and results of the ratings. However, our findings have to be interpreted with cautious since our analysis is based on a sample of physicians of a local German region.

Eight Questions About Physician-Rating Websites: A Systematic Review

To estimate the costs of palliative care for colorectal cancer (CRC) from the perspective of German statutory health insurance and to measure the patients’ quality of life (QoL) for a 2-year time period. A prospective observational multicentre study was carried out to estimate the direct costs of care over a 2-year period. Case report forms, medical records, and claims data were all applied to document medical and resource usage data in real-world settings. QoL was measured by using the Short Form-12 Health Survey. In total 101 patients (mean age 67.09 ± 11.13 years, 68 % male) from 12 different settings were included. The mean costs per patient during the 1st and 2nd years were calculated to be 42,361€ and 32,023€, respectively. Highest mean costs were calculated for the second quarter, which reached an amount of 12,900€ (95 % CI: 11,127€–14,673€). Mean physical summary scores and mean mental summary scores were 41.8 and 49.7, respectively. This is the first study assessing the costs of palliative care and the quality of life of patients with CRC in real-world health-care delivery in Germany. It could be shown that CRC treatment represents an enormous economic burden to the German health-care system. Increased efforts in promoting effective and efficient treatment options, or performance-based medication reimbursement schemes, might be helpful in reducing the costs.

SummaryBackground: Physician rating websites (PRWs) are gaining in popularity among patients seeking quality information about physicians. However, little knowledge is available about the quantity and type of information provided on the websites.Objective: To determine and structure the quantity and type of information about physicians in the outpatient sector provided on German-language physician rating websites.Methods: In a first step, we identified PRWs through a systematic internet search using German keywords from a patient´s perspective in the two search engines Google and Yahoo. Afterwards, information about physicians available on the websites was collected and categorised according to Donabedian´s structure/process/outcome model. Furthermore, we investigated whether the information was related to the physician himself/ herself or to the practice as a whole.Results: In total, eight PRWs were detected. Our analysis turned up 139 different information items on eight websites; 67 are related to the structural quality, 4 to process quality, 5 to outcomes, and 63 to patient satisfaction/experience. In total, 37% of all items focus specifically on the physician and 63% on the physician’s practice. In terms of the total amount of information provided on the PRWs, results range from 61 down to 13.5 items.Conclusions: A broad range of information is available on German PRWs. While structural information can give a detailed overview of the financial, technical and human resources of a practice, other outcome measures have to be interpreted with caution. Specifically, patient satisfaction results are not risk-adjusted, and thus, are not appropriate to represent a provider’s quality of care. Consequently, neither patients nor physicians should yet use the information provided to make their final decision for or against an individual physician.

Public Reporting (PR) gewinnt zunehmend an Bedeutung bei dem Versuch der Patientensteuerung. Daher soll untersucht werden, welche Ergebnisse bezüglich der Effektivität von PR vorliegen und ob sich die Ergebnisse in Abhängigkeit des PR-Instrumentes unterscheiden. Die herausgearbeiteten Erfolgsfaktoren können insbesondere der in Deutschland zunehmenden Transparenz-Bewegung zugutekommen. Systematischer Review mit Literatursuche in den folgenden 5 Datenbanken: The Cochrane Library, Medline (via PubMed), ISI Web of Knowledge, EconLit und PsycINFO. Peer-­reviewed Artikel in den Sprachen Englisch, Deutsch und Spanisch wurden für den Zeitraum seit 2005 gesucht. Studien vor diesem Zeitraum, auf die wir durch Durchsicht der einbezogenen Literatur gestoßen sind, wurden ebenfalls integriert. Eine informelle Handsuche ergänzte die Suche. Wir identifizieren insgesamt 21 Studien, in denen die Auswirkungen 12 verschiedener PR-Instrumente auf den Patientenfluss untersucht werden. 20 Studien betrachten Erfahrungen aus den USA, eine Studie kommt aus Deutschland. Das am häufigsten untersuchte PR-Instrument ist das New York State Cardiac Surgery Reporting System (CSRS), das in 8 Studien betrachtet wurde. Als Gesamtergebnis hat sich ergeben, dass in 9 Studien ein Effekt auf die Patientensteuerung gezeigt wurde, während 7 Untersuchungen zu keinem eindeutigen Ergebnis kom­men und fünf Studien keinen Effekt nachweisen konnten. PR kann effektiv sein bei dem Versuch, den Patientenfluss zu steuern. Insbesondere bei elektiven Eingriffen hat sich eine Wirksamkeit gezeigt. Um erfolgreich zu sein, müssen die dargestellten Informationen glaubwürdig und verständlich sein, eine Neuigkeit darstellen, verbreitet werden sowie anwendbar und gemäß individueller Präferenzen darstellbar sein. Public reporting (PR) has been gaining more weight as a mechanism for patient steerage. According to the theory of PR, patients use information about the quality of health care providers before making decisions and selecting health-care providers. This paper contributes further knowledge on the effectiveness of PR and identifies critical success factors. These should be taken into account when implementing PR in the German health care system. The peer-reviewed English, Spanish, and German language literature was searched in the following five databases: The Cochrane Library, Medline (via PubMed), ISI Web of Knowledge, EconLit, and PsycINFO (since 2005). In addition, reference lists of the included studies and reviews were screened in order to identify previously published studies. In total, 21 studies were identified regarding the impact of 12 different PR instruments on patient steerage. An impact could be demonstrated in 9 studies, 7 studies showed mixed results, while 5 studies could not show any effect on patient steerage. 20 studies were carried out in the US environment, 1 study in Germany. The most researched instrument is the New York State Cardiac Surgery Reporting System (N=8). PR can be effective in steering pa­tients when seeking a health-care provider, especially for elective procedures. To be successful, information provided must be reliable, easily understandable, should further represent real news, and be disseminated widely. Besides this, it has to be applicable and modifiable according to individual preferences.