David Scheller-Kreinsen

We analysed patient‐level data (n = 72 235) from 563 hospitals in 10 European countries to assess the ability of national diagnosis‐related group (DRG) systems to account for patient‐level variation in cost or lengths of stay of breast cancer surgery patients against a standard set of patient characteristics, treatment and quality variables. We find that European DRG systems use very different types of classification variables and numbers of DRGs (range: 3–7) to classify these patients. In 6 of 10 countries, the set of patient characteristics, treatment and quality variables, which we were able to define across countries, perform better than the set of national DRGs in accounting for patient‐level variation in resource consumption. Moreover, there appear to be factors that are consistently significant determinants of cost/length of stay of breast cancer surgery cases but are not, or at least not fully, considered in European DRG systems. Our results therefore raise concerns as to whether all systems rely on the most appropriate classification variables. In several countries, policymakers should reevaluate the appropriateness of their DRG algorithm for breast cancer surgery and of specific DRG weights. Copyright © 2012 John Wiley & Sons, Ltd.

The common starting point of many studies scrutinizing the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth. Using representative data from the German Socioeconomic Panel, we apply Fields' regression based decomposition techniques to decompose variations in health into its sources. Controlling for income, education, occupation, and wealth, we assess the relative importance of the explanatory factors over and above their effect on the variation in health channelled through the commonly applied measures of socioeconomic status. The analysis suggests that three main factors persistently contribute to variance in health: the capability score, cultural-behavioural variables and to a lower extent, the materialist approach. Of the three, the capability score illustrates the explanatory power of interaction and compound effects as it captures the individual's socioeconomic, social, and psychological resources in relation to his/her exposure to life challenges. Models that take a reductionist perspective and do not allow for the possibility that health inequalities are generated by factors over and above their effect on the variation in health channelled through one of the socioeconomic measures are underspecified and may fail to capture the determinants of health inequalities.

Deutschland, England und alle anderen EU Mitgliedsstaaten befinden sich in wirtschaftlich schwierigen Zeiten, in denen entscheidende gesundheitspolitische Veränderungen anstehen – auf nationaler wie auch auf europäischer Ebene. So existiert ein zunehmendes Bedürfnis, Erfahrungen über die Grenzen hinweg auszutauschen. Daher richten das "Wissenschaftliche Institut der TK für Nutzen und Effizienz im Gesundheitswesen" (WINEG), die Techniker Krankenkasse (TK) und die European Health Management Association (EHMA) aus Brüssel die zweite European Health Care Conference 2011 mit internationalen Gesundheitsexperten aus Politik, Wissenschaft und Management aus. Dieser Konferenzband vereint zehn Beiträge, die sich mit Gesundheitsreformen, Finanzierung und Versorgung auseinandersetzen, insbesondere auch mit aktuellen Trends im Krankenhaussektor, bei Patientennutzen und EU Auslandsversorgung. Hierdurch soll die Diskussion über Qualitäts- und Effizienzverbesserungen angeregt werden: Wie ähnlich sind die Herausforderungen in England und Deutschland? Wenn Bismarck und Beveridge sich getroffen hätten, was hätten sie voneinander gelernt? Und welche Gedanken hätten sie zur Europäisierung des Gesundheitswesens?