[Declared dead? Recommendations regarding integrated care from the perspective of German statutory health insurance]. / Totgesagte leben länger : Empfehlungen zur Integrierten Versorgung aus Sicht der gesetzlichen Krankenkassen.

The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germany's statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germany's SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germany's SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal government's innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.

[Characteristics of integrated care programmes and their impact on patient benefit: a discrete-choice experiment for integrated care networks]. / Eigenschaften von integrierten Versorgungs-programmen und deren Einfluss auf den Patientennutzen: Ein Discrete-Choice Experiment für Versorgungsnetzwerke.

PURPOSE: Innovative care models shall reduce the frictional losses in health-care. The successful implementation of care networks requires the acceptance by the health care providers, by the patients and citizens as well as by the payers. The consideration of preferences is an essential factor for success. The aim of this study is to analyse patient preferences. METHODS: With the help of Discrete-Choice experiment 21 patient-relevant attributes of innovative healthcare programmes were examined. On the basis of a balanced overlapping design (sawtooth) a total of 140 choice sets with the highest possible D efficiency was generated. The 21 attributes were divided into 4 thematic priorities for analysis. The cost attribute was integrated as a uniform comparator. The evaluation was done by a random effects logit estimation (STATA). RESULTS: The representative samples (N=1 322) revealed that in all 4 DCE blocks the attribute "additional costs" had the strongest influence on the patients choice (1: coeff.; 1.047; 2: coeff.: 1.105; 3.: coeff.: 0.956; 4.: coeff.: 0.954). This was followed by "medical apparatus and facilities", "waiting time for an appointment", "professional experience", "travelling time to treatment site", and "exchange of clinical information". "Transfer management" and "consideration of individual circumstances" for example, had a small influence on patient choice. CONCLUSION: In order to increase the acceptance of innovative health-care programmes preferences must be known and integrated into the design of the services. The present study has attempted to depict the patients' perspectives towards the new care systems. The individual selection decisions were not, as would be expected, influenced by the innovative approaches such as case management or shared decision making but rather by the quality of the infrastructure, the waiting times and professional experience.

[Care guidance and management of cooperative healthcare networks]. / Versorgungssteuerung und Management kooperativer Gesundheitsnetzwerke.

Selective agreements offer the possibility to the health insurers to influence the control of care, a chance that they urgently need because of cost pressure. The concepts of care can be developed top-down and then a health insurer can make an offer. Or these concepts are developed bottom-up that means a chance for the healthcare providers who want to actively shape the medical care. An essential component for all these concepts is to be able to calculate and administrate funding and control. Pathways are necessary for controlling the treatment which not only have to be developed but also have to be put into practice. The pathway acute sacroiliac pain developed by the Lübeck doctors' network will be described here as an example of a successful implementation.