[Development of Social Medicine and Public Health in Germany]. / Entwicklungslinien der Sozialmedizin und Öffentlichen Gesundheit in Deutschland.

Social medicine in Germany has multiple lines of tradition, which are marked by the presence of 2 German states and their re-unification and by the (re-)establishment of multidisciplinary public health by the end of the twentieth century. At the same time, a differentiation within the applied fields of social medicine into several thematic topics can be observed. These can be grouped in a first step into the domains of clinical social medicine, of social medicine for social insurance purposes and of a population-oriented social medicine. For social medicine as a scientific discipline within the broad context of medicine, the requirement of a context-adequate development, which encompasses the special methods of multidisciplinary public health, poses big challenges. For successfully meeting these challenges and going beyond population-oriented public health and for bridging the gap between the individual and the social medical institutions of the health system, it is indispensable for social medicine to be independent of other disciplines within the array of medical specialties. The present study argues for strengthening social medicine within the medical faculties. Chairs for social medicine and public health are not only in the interest of the applied fields of social medicine, but represent also an indispensable scientific discipline which can relate and contribute to all specialties of medicine.

[Future needs in health protection and preventive health]. / Aspekte künftiger Gestaltungsbedingungen für den Gesundheitsschutz und die Prophylaxe.

Health protection is a social political program and dosely connected with the social development. It is pointed out that progress in health protection demands progress in social development. One of the main problems of preparing health protection strategies is to assess the numberless risks for health. Because of the fact that risk assessment is full of social implications people have to be involved in assessing risks. Stressing this fact it is concluded that concepts of health protection mainly reflect ideas about people and social life more than ideas about health and illness. Promoting health protection in the GDR four key problems of major concern are summarized: 1) improving information and education, 2) netting the responsibility of the whole society, 3) further progress in socialist democracy and communal life, 4) increasing the role of health protection in the whole social-political activities.

[Measurement of epidemiological facts in dentistry]. / Die Messung epidemiologischer Sachverhalte im Anwendungsfall der Stomatologie.

Recent epidemiological investigations about caries report about phenomenons like "caries increase" or "caries decline". This kind of observation bases on prevalence-studies. But describing such phenomenons does not give the opportunity to explain the observations. For that purpose the modern methodology of epidemiology should be used. Despite of the fact that epidemiology differs exactly between incident and prevalent cases, the use of incidence studies seems to be extremely seldom in stomatology. This paper discusses the problems, which occur in incidence-studies about caries and especially in cohort-studies. The authors show the difficulties to adopt terms like incidence density and cumulative incidence to studies about caries. A proposal is given in order to adopt the modern methodology of epidemiology to the special problem of caries.

[The "Barthel Index": alternative to expertising in compulsory care insurance?]. / Der Barthel-Index: eine Alternative zum Begutachtungsverfahren in der Pflegeversicherung?

Measuring the level of care needed is difficult and since the introduction of nursing care insurance in Germany in 1995 the assessment method applied by the MDK (Medizinischer Dienst der Krankenversicherung) has repeatedly been criticised. The method is very costly and not broadly tested for its validity and reliability. The question arises whether similar results can be obtained by applying another instrument, like the Barthel Index (BI), which is easier to use and more reliable. In this article the authors show - based on a preliminary study in 1999 - that by using the Barthel Index a discriminance analysis will show identical results in 80 % of all cases. The authors regard this identical measurement of care needs, which is reached by scoring only ten items (BI) versus thirty (MDK's assessment method) and with a presumingly higher reliability, as a major progress and reason enough for further discussion and studies of the use of the Barthel Index for care needs assessment.

[Managed care--a possibility for German Health Insurance?]. / Managed care--eine Perspektive für die GKV?

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.