Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured.

BACKGROUND: Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system. METHODS AND ANALYSIS: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography. DISCUSSION: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.

Use of Self-Medication with Homeopathy in Germany: Results of an Online Questionnaire Survey.

BACKGROUND: Little is known about self-medication with homeopathic drugs in Germany. The aim of this study was to gain information about users, sources of information and the selection process of the drugs. METHODS: An online questionnaire survey among users of self-medication with homeopathy was conducted via social media and email newsletters. RESULTS: A total of 665 users who responded to the questionnaire were included. Most of the respondents were women (92%) in their mid-forties with high educational status. In total, 43% of the participants reported a household member working in the health sector. Books (65%) and Internet (47%) were the most common sources of information. Consultations in pharmacies - with a mean duration of 10 min - were likely to be used (60%). Homeopathic drugs were mainly used in the potency D12 (55%), for a duration of 5 days, 3 times daily, with 5 globules. Homeopathic drugs were mainly used due to good therapeutic experiences in the past (82%). Indications for use were acute diseases (91%), particularly colds (86%), as well as chronic diseases (51%) and prevention (47%). The selection of a homeopathic drug took the participants 25 min on average. CONCLUSION: Homeopathic self-medication is understood by users as a resource to regain, maintain, and promote health. Further research about the quality and applicability of information for homeopathic self-medication is necessary.