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The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.
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The nursing care assistance system in Germany is an integral part of the overall payment of long-term care insurance,and as the last line of defense of"multiple subjects sharing",its payment mechanism accurately identifies individual overflow nursing care needs and provides differentiated guarantee.This study proposes the"risk-embedded need spillover theory"based on the need spillover theory and applies this theory to analyze how the payment mechanism of care assistance system in Germany provides differentiated guarantee,and found that the payment mechanism classified families'ability and resources from the perspective of risk.In the context of building a care protection system,learning Germany's experience is an effective way to cope with the problem of inadequate care protection in China.
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Resumen Este artículo aborda la presencia de la República Federal de Alemania, entre los años 1960 y 1980, en el campo de la Educación Física y del deporte en tres países suramericanos: Brasil, Argentina y Colombia. Muestra algunos de los desdoblamientos que los acuerdos firmados con el país europeo proporcionaron a las prácticas educacionales y científicas en cada realidad investigada. Además de esto, presenta los principales sujetos involucrados en el proceso y como actuaron en estos diferentes lugares.
Resumo Este artigo aborda a presença da República Federal da Alemanha, entre os anos 1960 e 1980, no campo da Educação Física e do esporte em três países sul-americanos: Brasil, Argentina e Colômbia. Apresenta alguns dos desdobramentos que os acordos assinados com o país europeu proporcionaram às práticas educacionais e científicas em cada realidade investigada. Além disso, faz conhecer os principais sujeitos envolvidos no processo e como atuaram nesses diferentes lugares.
Abstract This article highlights the presence of Federal Republic of Germany, between 1960 and 1980, in the field of Physical Education and Sport in three South America countries: Brazil, Argentina and Colombia. It shows, in each reality, the effects produced by agreements with that european country and their consequences in educational and scientific practices. Besides, the paper reveals important names of this process and how they acted in those different places.
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Abstract In this interview, Volker Roelcke explains and analyzes historical evidence refuting erroneous assumptions about medical atrocities committed by physicians during the Nazi era, provides insight into the implications of medicine during the Nazi period and the Holocaust for medicine and bioethics today, analyzes the history of the term "genocide," and suggests formats for future teaching, among other topics.
Resumen En esta entrevista, Volker Roelcke explica y analiza evidencia histórica que refuta las suposiciones erróneas acerca de las atrocidades cometidas por los médicos durante la era nazi, brinda información sobre las implicaciones de la medicina durante el período nazi y el Holocausto para la medicina y la bioética en la actualidad, analiza la historia del término "genocidio", y sugiere formatos para la enseñanza futura, entre otros temas.
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Bioethics , National Socialism , Genocide , History of Medicine , History, 20th CenturyABSTRACT
Germany owns the largest herbal market in Europe and has the world's leading R&D capabilities for herbal medicine products. Chinese herbal medicine (CHM) spreaded to Germany hundreds of years ago. Since the beginning of the 20th century, China and Germany have signed a series of agreements to support traditional medicine cooperation, and the exchange of herbs between China and Germany has become more frequent, bringing opportunities for CHM to enter into Germany. In recent years, China and Germany have gained progress in the fields of CHM research and trade, etc. However, there are differences in the understanding of herbal medicines, quality standard evaluation, usage, and medication rules between the two countries. By doing SWOT analysis of the development of CHM in Germany, this paper suggested to promote Sino-German medical exchanges and build a community of common health for mankind through strengthening the clinical application of CHM, finding new ways of CHM entering into German market, and building an international talent team of traditional Chinese medicine.
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German family physicians practice independently in clinics, and provide primary health care services. General practitioners are a type of specialists. The basis for the self-management of German doctors is the homogeneous medical education in Germany. The new round of medical education reform emphasizes the theory and practical training throughout the entire process of medical education. All medical students in Germany need to go to the clinic for internship and be familiar with primary health care models. Post-graduation education sets rotation plans and assessment standards according to the characteristics of general practice specialties, emphasizes the clinical practice time in the clinics, and urges doctors to continue medical education through the payment of medical insurance. This article draws on the German general practitioner training model, proposes to strengthen the enlightenment of general practice education during the education of undergraduate medical colleges, and strengthen the clinical practice of general practitioners and the construction of general practice training bases, as well as improve the ability of the community physician faculties, in order to provide a reference for the training of general practitioners in China.
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RESUMEN Objetivo: Examinar las transiciones migratorias de profesionales de enfermería mexicanos que residen en Alemania. Material y Método: Estudio cualitativo de tipo etnográfico focalizado, guiado por la Teoría de Transiciones; se realizó entre los meses de noviembre de 2020 y mayo de 2021; se utilizó un muestreo por bola de nieve, donde los participantes de la red social Facebook, que aceptaron participar, hicieron referencia a otras personas. Se reclutaron a 11 profesionales de enfermería mexicanos; se realizaron entrevistas por Zoom, audiograbadas con previo consentimiento. La información obtenida fue transcrita en su totalidad y examinada mediante el análisis temático con el apoyo del software QUIRKOS. Resultados: El 63,6% fueron mujeres con una edad promedio de 30,8 años y un tiempo promedio de 1,26 años en Alemania. Las transiciones migratorias se clasificaron en 10 categorías: 1) Condiciones económicas y laborales, 2) Idioma, 3) Proceso de homologación de estudios, 4) Costos, 5) Discriminación, 6) Costumbres y tradiciones, 7) Gastronomía, 8) Clima, 9) Recreación y 10) Seguridad. Conclusiones. Conocer las transiciones migratorias de profesionales de enfermería mexicanos en Alemania permite realizar una serie de recomendaciones a la práctica, las políticas públicas y futuros proyectos de investigación e intervención.
ABSTRACT Objective: To examine the migration transitions of Mexican nursing professionals residing in Germany. Materials and Methods: A focused ethnography guided by the Theory of Transitions was conducted between the months of November 2020 and May 2021; snowball sampling was used, where the participants of the social network Facebook, who agreed to participate, referred to other people. Eleven Mexican nurses living in Germany were recruited; interviews were conducted using the Zoom platform and audio-recorded with prior consent. The information obtained was transcribed verbatim and examined through thematic analysis using the QUIRKOS software. Results: 63.6% of the nurses were women, with an average age of 30.8 years; and an average time of 1.26 years living in Germany. Migration transitions were classified into 10 categories: 1) Economic and labor conditions, 2) Language, 3) Study accreditation process, 4) Costs, 5) Discrimination, 6) Customs and traditions, 7) Gastronomy, 8) Climate, 9) Recreation, and 10) Safety. Conclusions: Understanding the migration transitions of Mexican nurses in Germany allows us to make a series of recommendations for practice, public policies, and future research and intervention projects.
RESUMO Objetivo: Examinar as transições migratórias de profissionais de enfermagem mexicanos que residem na Alemanha. Material e Método: Estudo qualitativo de tipo etnográfico focado, guiado pela Teoria das Transições e realizado entre os meses de novembro de 2020 e maio de 2021. Utilizou-se uma amostragem de bola de neve, na qual os participantes da rede social Facebook, que concordaram em participar, contactaram outras pessoas. Onze profissionais mexicanos residentes na Alemanha foram recrutados; foram realizadas entrevistas usando a plataforma Zoom e gravadas em áudio com consentimento prévio. As informações obtidas foram transcritas textualmente e examinadas por meio de análise temática utilizando o software QUIRKOS. Resultados: 63,6% dos profissionais de enfermagem eram mulheres, com idade média de 30,8 anos; e tempo médio de 1,26 anos vivendo na Alemanha. As transições migratórias foram classificadas em 10 categorias: 1) Condições econômicas e trabalhistas, 2) Idioma, 3) Processo de acreditação de estudos, 4) Custos, 5) Discriminação, 6) Costumes e tradições, 7) Gastronomia, 8) Clima, 9) Lazer, e 10) Segurança. Conclusões: Conhecer as transições migratórias dos profissionais de enfermagem mexicanos na Alemanha permite fazer uma série de recomendações para a prática, as políticas públicas e os futuros projetos de pesquisa e intervenção.
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OBJECTIVE：To provide reference for improving medical insurance reimbursement for multi-indication drugs based on value-based pricing in China. METHODS：The theory and practice of value-based pricing for multi-indication drugs were sorted out，and the value standards and medical insurance reimbursement strategies based on value-based pricing in France，Germany，UK，Italy and Sweden were analyzed，so as to provide the suggestions for medical insurance reimbursement of multi-indication drugs in China. RESULTS & CONCLUSIONS：The realization of value-based pricing first needed to develop a value framework to define，measure and integrate value，and then established a model to convert the total value into price. The overall idea of value-based pricing for multi-indication drugs was consistent，but there were differences in the value standard. In the UK and Sweden， quality-adjusted life years （QALYs） and incremental cost-effectiveness ratios （ICERs） measured by pharmacoeconomicsare used as the value standard. France，Germany and Italy were more focused on the therapeutic value and clinical benefit improvement. As for medical insurance reimbursement strategies，France adopted single weighting method based on expected volume. Germany adopted combination weighting method based on value and volume. UK introduced the Patient Access Schemes and Italy introduced the Managed Entry reements，both based on the nominal reimbursement standard. Sweden adopted independent reimbursement for different indications by different brand names. It is suggested that China can explore the value-based pricing strategies of multi-indication drugs on the basis of the above international experiences，reference and use these variety of medical insurance reimbursement strategies comprehensively. Simultaneously，the information collection mechanism of patients and drug use should be improved to provide data support for the implementation of China’s value-based pricing and reimbursement strategies for multi-indication drugs.
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Resumo O presente estudo tem o objetivo de determinar a forma como estudantes de diferentes culturas percebem a utilidade das aulas de Educação Física. Foram entrevistados 2.748 estudantes (1.373 da região da Araucanía, Chile; e 1.375 do Estado de Sarre, Alemanha). Tanto os alunos chilenos como os alemães reconhecem mais uma utilidade "esportivo-recreativa" que uma "socioeducativa", e os chilenos apresentam valores mais altos que seus pares alemães; por outro lado, ambos os grupos manifestam seu desacordo com a opinião de que a Educação Física não lhes serve para nada. Os estudantes consideram que suas aulas de Educação Física foram úteis, o que surge como uma oportunidade para reforçar a geração de experiências positivas nas aulas e consolidar as aprendizagens.
Abstract The aim of this study is to show how the students of different cultures perceive their physical education classes. 2748 students (1373 from the Araucania Region in Chile and 1375 from Saarland in Germany) have been surveyed. The students of both countries agree that the "sportive-recreational" aspect is more important than the "social-educational" one, while the Chilean students present higher values than the German students do. In addition, the students of both countries disagree to the statement that physical education is useless for them. The Chilean and German students think that their physical education class is useful. This knowledge can be used as an opportunity to reinforce the generation of positive experiences in class and to consolidate the learning processes.
Résumé L'objectif de cette étude est de déterminer la façon dont des étudiants issus de cultures différentes perçoivent l'utilité des classes d'Éducation Physique. 2748 élèves (1373 de la région d'Araucania, au Chili; et 1375 de l'État de Sarre, en Allemagne) ont été interrogés. Les étudiants chiliens et allemands reconnaissent une utilité plus "sportive-récréative" que "socio-éducative", les valeurs présentées par les Chiliens sont cependant plus élevées que chez les allemands. En outre, les deux groupes expriment leur désaccord quant à l'opinion que l'éducation physique ne leur apporte rien. Dans l'ensemble, les élèves considèrent que les cours d'Éducation Physique ont été utiles, ce qui représente une opportunité pour renforcer les expériences positives en classe et pour consolider les apprentissages.
Resumen El presente estudio tiene como propósito determinar cómo escolares de diferentes culturas perciben la utilidad de las clases de Educación Física. Fueron encuestados 2748 escolares (1373 de la Región de La Araucanía, Chile; y 1375 del Estado de Sarre, Alemania). Tanto los escolares chilenos como los alemanes reconocen una utilidad "deportivo-recreativa" por sobre una utilidad "socioeducativa", siendo los chilenos quienes presentan valores más altos que sus pares alemanes; además, ambos grupos manifiestan su desacuerdo en que la Educación Física no les ha servido para nada. Los escolares consideran que sus clases de Educación Física les han sido útiles, lo que se presenta como una oportunidad para reforzar la generación de experiencias positivas en las clases y consolidar los aprendizajes.
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Resumo Este artigo oferece uma (re)descrição do Convênio Colombo-Alemão (1973-1984) na educação física colombiana. Metodologicamente, elege a revista Educación Física y Deporte como fonte, ocasião para analisar seu conteúdo. A investigação questiona a tese de que esse acordo foi responsável pela esportivização da disciplina; sugere, por sua vez, que a influência alemã no país andino, além de plural, foi acompanhada de um debate sobre o significado da(s) ciência(s) do esporte e sua relação com a educação física.
Abstract This paper presents a (re)description of the Colombian-German agreement (1973-1984) and its impacts on the Colombian Physical Education. As for the methodology, the research source is the journalEducación Física y Deporte(Physical Education and Sports) for the analysis of the articles content. The study questions the thesis that this agreement was responsible for the sportivization of this school subject and suggests, in turn, that the German influence on the Andean country, besides being plural, was accompanied by a debate about the meaning of the Sports Science(s) and its/their relationship with Physical Education.
Resumen Este artículo ofrece una (re)descripción del convenio colombo-alemán (1973-1984) y sus repercusiones en la educación física colombiana. Metodológicamente, elige la revista Educación Física y Deportecomo fuente y analiza su contenido. La investigación cuestiona la tesis de que ese acuerdo fue el responsable de la deportivización de la disciplina y sugiere, al mismo tiempo, que la influencia alemana en el país andino, además de plural, estuvo acompañada por un debate sobre el significado de la(s) ciencia(s) del deporte y su relación con la educación física.
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In Japan, medical schools are making various efforts for the purpose of establishing consistent admission selection processes for securing human resources, which are compatible with individual development goals as medical doctors and admission policies. In Germany, 40% of medical students are selected through the central office (Stiftung fuer Hochschulzulassung) for the allocation of places in higher education, The rest of the students are decided by Medical Universities. In addition to overall Abitur grade, the nationwide medical admission test TMS (Test fuer Medizinische Studiengaenge) is used as one of the selection criteria by many universities in individual selection processes with the aim of choosing the students with better medical specialty aptitude. Similar attempts might be difficult in Japan where private and public universities are mixed. However, it is important to share the firm concept of ‘what type of students should be selected as medical students’. Here, we introduce the unique selection process of medical students in Germany, especially focusing on the re-introduction of TMS.
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OBJECTIVES: The objective of the present study was to validate a shortened transformational leadership (TL) scale (12 items) comprising core TL behaviour and to test the associations of this shortened TL scale with depressive symptoms. METHODS: The study used cross-sectional data from 1632 employees of the overall workforce of a middle-sized German company (51.6% men; mean age, 41.35 years; standard deviation, 9.4 years). TL was assessed with the German version of the Transformational Leadership Inventory and depressive symptoms with the Hospital Anxiety and Depression Scale (HADS). The structural validity of the core TL scale was assessed with confirmatory factor analysis. Associations with depressive symptoms were estimated with structural equation modelling and adjusted logistic regression. RESULTS: Confirmatory factor analysis and structural equation modelling showed better model fit for the core TL than for the full TL score. Logistic regression revealed 3.61-fold (95% confidence interval [CI], 2.20 to 5.93: women) to 4.46-fold (95% CI, 2.86 to 6.95: men) increased odds of reporting depressive symptoms (HADS score >8) for those in the lowest tertile of reported core TL. CONCLUSIONS: The shortened core TL seems to be a valid instrument for research and training purposes in the context of TL and depressive symptoms in employees. Of particular note, men reporting poor TL were more likely to report depressive symptoms.
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Humans , Male , Anxiety , Depression , Germany , Leadership , Logistic Models , Occupational HealthABSTRACT
The German ( Kooperation für Transoarenz und Qualit?t im Gesundheitswesen, KTQ) certification system was officially launched in Germany in December 2001. Over ten years′ development proves that the KTQ certification system as a high standard medical management system. The authors introduced its background, the update of certification content and procedures, and explained its characteristics and advantages.These insights provide valuable references for establishing a professional and efficient quality certification system, suitable for China′s social and economic development level.
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Resumo Desde os anos 1980, os sistemas de saúde europeus vêm passando por várias reformas, com ênfase à tendência de sua mercantilização. O objetivo deste artigo é evidenciar formas de implementação de mecanismos de mercado no funcionamento desses sistemas, alemão, britânico e francês - a partir da década de 1980. As reformas "mercantis" eram justificadas a partir da premissa de que a inserção da lógica de mercado poderia tanto diminuir a necessidade de gastos públicos como aumentar a eficiência dos existentes. O trabalho apresenta diferentes formas de mercantilização implementadas nas reformas, com a distinção entre os processos de mercantilização explícita, em que há efetivo aumento da presença privada, e implícita, em que ocorre a incorporação de princípios advindos do setor privado no sistema público, tanto no financiamento como na prestação de serviços de saúde. Além do detalhamento das diferentes maneiras em que este fenômeno se expressa, o artigo apresenta brevemente os potenciais efeitos negativos desse processo para os sistemas de saúde, principalmente em termos de acesso e equidade, explicitando que as premissas iniciais em torno da mercantilização (redução de gastos e melhora na eficiência) parecem ser falsas.
Abstract Since the 1980s, European health systems have undergone several reforms, with emphasis on the tendency of their commodification. The objective of this article is to demonstrate how market mechanisms were implemented in the functioning of these systems, german, british and french - from the 1980s. The "mercantile" reforms were justified on the premise that the insertion of market logic could both reduce the need for public spending and increase the efficiency of existing expenditure. The work presents different forms of commodification implemented in the reforms, with the distinction between processes of explicit commodification, in which there is an effective increase in private, and implicit presence, in which there is incorporation of principles from the private sector in the public system, both in financing and in the provision of health services. In addition to detailing the different ways in which this phenomenon is expressed, the article briefly presents the potential negative effects of this process for health systems, especially in terms of access and equity, stating that the initial assumptions surrounding commodification (cost reduction and efficiency improvement) appear to be false.
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Humans , Health Care Reform , Delivery of Health Care/organization & administration , Commodification , Health Expenditures , Public Sector/economics , Private Sector/economics , Delivery of Health Care/economics , France , Germany , United KingdomABSTRACT
As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the "Golden Standard" of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.
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Humans , Disaster Medicine , History , Emergency Medical Services , History , Emergency Medicine , History , Germany , History, 20th Century , History, 21st Century , RegistriesABSTRACT
In response to the increasing burden of chronic diseases, many countries have launched the reform of the health system. Based on the Diagnoses Treatment Combination (DTC) and Healthy Kinzig-tal Gesundes Kinzigtal (GK), this paper elaborates on the experience of chronic diseases management during different populations in Germany and the Netherlands. Based on the scientific decision-making and system integration, the DTC builds a multidisciplinary team to achieve individualized and continuous integrated disease management. The GK model focuses on health promotion, extensively integrated social resources, to achieve the goal of reducing the incidence of chronic diseases and controlling the cost. This provides a useful reference for the building of Healthy China: integrating resources from the supply side and the demand side, strengthening the integration of the health service system, promoting citizen engagement and improving individual health literacy, so as to achieve universal health.
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Analisamos o livro Body by Weimar, de Erik N. Jensen. Ao estudar questões de gênero na história do esporte na Alemanha após a primeira guerra mundial, endossamos os procedimentos metodológicos adotados pelo autor no desenvolvimento da obra. Eles podem estimular novos caminhos à pesquisa histórica no campo da Educação Física.
We have analyzed the book Body by Weimar, Erik N. Jensen. By studying gender issues in sports history in Germany after the first world war, we endorse the adopted methodological procedures. They can stimulate new ways of historical research in the field of Physical Education. Therefore, we affirm the importance of the work.
Hemos analizado el libro Body by Weimar, de Erik N. Jensen. Mediante el estudio de las cuestiones de género en la historia del deporte en Alemania después de la primera guerra mundial, estamos de acuerdo con los procedimientos metodológicos adoptados. Pueden estimular nuevas formas de investigación histórica en el campo de la educación física. Por lo tanto, afirmamos la importancia de la obra.
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Soccer , Sports/history , Athletes , Gender Identity , GermanyABSTRACT
Herbal medicine and Chinese materia medica (CMM), Kampo, traditional medicine in Australia, and other traditional medicines have been an important part of the world medicine, and the patent protection strategies of herbal medicine and Kampo at the international level have been already quite mature. However, China have less experience in patent protection strategies of CMM, and apparently fall behind the herbal medicine patent protection strategies of European countries, especially Germany. In this paper, based on the perspective of research and development, the patent application and protection strategies of Tebonin® from Germany are analyzed in depth. Considering patent conservation status of CMM, some workable references for the domestic pharmaceutical enterprises of CMM in the field of research and development of new drugs are provided.
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Germany has a similar health insurance system as China, and has already formed standardized management processes as well as efficient decision-making transformation paths for health technology assessment (HTA) that perform well mainly based on three major HTA institutions at the national level.The HTA decision-making transformation system in Germany has proven to be a typical representative in evidence-based decision-making for health policies worldwide.Based on the outcomes of literature analysis and field research, this paper summarizes the paths and methods of Germany's HTA decision-making transformation, and finally proposes several targeted policy recommendations to promote the HTA decision-making transformation in China.
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OBJECTIVE:To provide reference for improving the drug price regulation policy in China. METHODS:Literature research,system comparison and other methods were used to summarize the commonalities and characteristics of drug price regula-tion policy in Germany,Japan and Taiwan area of China,and the successful experience was learned. RESULTS & CONCLU-SIONS:Drug price management in Germany,Japan and Taiwan area of China has their own characteristics. Germany conducted reference price system and new drug pricing mechanism,which was the first country to introduce the reference price system. Japan granted price premiums to innovative drugs,decreased pricing for generic drugs and adjusted drug price again. And Taiwan area of China classified and grouped differential pricing to encourage competition negotiation and regularly investigated drug prices and pric-ing. Germany,Japan and Taiwan area regard medicare pay price as core of drug price management,adopt comprehensive means to regulate the drug price,and pay attention to the monitoring and regular adjustment of market price as well. Price negotiation,phar-macoeconomics and multiple pricing methods are broadly used. Value-based drug pricing system is new trend of price policy re-form. It can be used for reference to improve the drug price regulation system in China.