[Success, satisfaction and improvement of informed consents for computed tomography : A survey among patients and physicians]. / Aufklärungserfolg, Zufriedenheit und Verbesserungsmöglichkeiten bei Computertomographie-Aufklärungen : Eine Befragung von Patienten und Ärzten.

BACKGROUND: Providing informed consent before a computed tomography (CT) is important for the physicians and the patients. A personal interview about the procedure, risks, and possible alternatives is mandatory before a CT examination. METHODS: A survey was carried out on patient satisfaction with regard to the duration and content of informed consents of CT examinations. Physicians were also interviewed about the duration and content of CT informed consents. Another part of the survey dealt with the acceptance of technical innovations, such as information videos or tablets/PCs. RESULTS: A total of 512 patients and 106 physicians took part in the survey. The duration of the informed consent was estimated by the patients to be 4.08 min on average and 4.7 min by the physicians. The most detailed information given by the physicians regards side effects associated with contrast agents. Less information was given on possible diagnostic alternatives and the need for an examination. According to this, about 92% of all patients did not remember having received information about alternative examinations. Furthermore, 88.7% of the patients and 95.3% of the physicians recommended informed consent using interactive videos and animations, and 74% of the patients and 98.8% of the physicians recommended answering questions on tablet/PC. CONCLUSION: Patients estimated the duration of a CT informed consent to be a little bit shorter, although some patients did not remember the content very well. The acceptance of technical innovations was very high among the participants. The use of information videos and tablets/PCs could increase the success of providing informed consent.

[Analysis of documented informed consent forms for computed tomography : Completeness and data quality in four clinics]. / Analyse von dokumentierten Computertomographie-Aufklärungen : Vollständigkeit und Datenqualität in vier Kliniken.

BACKGROUND: Before performing a medical procedure, such as a computed tomography, an obligatory informed consent of the patient and its detailed documentation is necessary. METHODS: A total of 1424 informed consent forms for contrast-enhanced computed tomography from four clinics with different healthcare levels were analyzed. Informed consent forms were evaluated related to completeness, legibility and quality. RESULTS: In all, 1110 (77.9%) informed consent forms were sufficiently completed, 267 patients (18.8%) answered the form incompletely and 47 patients (3.3%) returned it without answering a question. Handwritten comments were found in 1391 (97.7%) cases. Thereof, 1329 (93.3%) were graded as detailed comments and 62 (4.4%) as less detailed comments. These comments were well legible in 675 (47.4%) cases, 558 (39.2%) informed consents showed limited legibility and in 158 (11.1%) more than 50% of the comments were unreadable. Signatures were complete in 1374 (96.5%) informed consent forms. CONCLUSION: The results show a better quality and documentation of informed consent forms for computed tomography obtained by radiology residents compared to radiological specialists. Compared to the radiologists, the non-radiologists performed significantly worse. The establishment of videos and use of digital informed consent forms could provide a possible solution.

[Simulation training as part of clinical risk management : A health economic view]. / Simulationstraining als Teil des klinischen Risikomanagements : Eine gesundheitsökonomische Betrachtung.

Working in anesthesiology is characterized by a complex environment in which effective teamwork with different disciplines as well as other professions (e. g. nursing staff and surgical assistants) is crucial. Clinical risk management includes all steps to prevent incidents and patient harm. An example for this is simulation training based on crisis resource management (CRM). This training course focuses on teaching non-medical skills using simulation manikins in order to enable employees to maintain patient safety under the adverse, ever-changing and unfamiliar conditions of a medical emergency. In detail, this involves skills, such as situation awareness, teamwork, decision making, task management and communication, whereby all elements must be taken equally into account to be effective in terms of CRM. A sustainable training aims to build up, promote and permanently establish a mindset within the team. Positive effects of these could be demonstrated for long-term training that addressed the entire patient care team and that was implemented along with various other patient safety measures. In addition, other positive aspects of simulation training, such as stronger employee retention or more effective task management in critical situations are described; however, hospitals are often found to have difficulties in financing these training sessions. This article shows possible health economic considerations in the discussion about financing CRM-based simulation training. Cost-benefit and cost-effectiveness analyses are difficult to perform. They require an individual planning. Regardless of this, simulation training enables participants to experience (simulation) and reflect their own actions in critical situations (debriefing). With the help of specially trained CRM instructors, deviations from expected behavior can be detected. This non-conformity can be used as a starting point for the establishment and further development of patient safety by a structural analysis of possible failures within the system. The decision to finance CRM-based simulation training remains a fundamental decision of the management of the respective hospital. In the near future, pressure from liability insurers to prevent incidents might increase. The inclusion of CRM-based simulation training as an integral component of clinical risk management could provide key benefits in contract negotiation.

Pregnancy care in Germany, France and Japan: an international comparison of quality and efficiency using structural equation modelling and data envelopment analysis.

OBJECTIVES: Healthcare systems in developed countries may differ in financing and organisation. Maternity services and delivery are particularly influenced by culture and habits. In this study, we compared the pregnancy care quality and efficiency of the German, French and Japanese healthcare systems. STUDY DESIGN: Comparative healthcare data analysis. METHODS: In an international comparison based mainly on Organisation for Economic Co-operation and Development (OECD) indicators, we analysed the health resources significantly affecting pregnancy care and quantified its quality using structural equation modelling. Pregnancy care efficiency was studied using data envelopment analysis. Pregnancy output was quantified overall or separately using indicators based on perinatal, neonatal or maternal mortality. RESULTS: The density of obstetricians, midwives, paediatricians and the average annual doctor's consultations were positively and the caesarean delivery rate negatively associated with pregnancy outcome. In the international comparison at an aggregate level, Japan ranked first for pregnancy care quality, whereas Germany and France were positioned in the second part of the ranking. Similarly, at an aggregate level, the Japanese system showed pure technical efficiency, whereas Germany and France revealed mediocre efficiency results. Perinatal, neonatal and maternal care quality and efficiency taken separately were quite similar and mediocre in Germany and France. In Japan, there was a marked difference between a highly effective and efficient care of the unborn and newborn baby, and a rather mediocre quality and efficiency of maternal care. CONCLUSION: Germany, France, and Japan have to struggle with quality and efficiency issues that are nevertheless different: in Germany and France, disappointing pregnancy care quality does not correspond to the high health care expenditures and lead to low technical efficiency. The Japanese system shows a high variability in outcomes and technical efficiency. Maternal care quality during delivery seems to be a particular issue that could possibly be addressed by legally implementing quality assurance systems with stricter rules for reimbursement in obstetrics.

[Instruments for Measuring the Effects of Early Intervention on Maintaining and Restoring Ability to Work in Germany: Opinion of an Interdisciplinary Working Group]. / Instrumente zur Messung von Effekten einer Frühintervention auf den Erhalt bzw. die Wiederherstellung der Arbeitsfähigkeit in Deutschland ­ Stellungnahme einer interdisziplinären Arbeitsgruppe.

OBJECTIVE: In projects on early intervention, a wide variety of instruments is used for the measurement of intervention effects on preservation or restoration of ability to work. The aim of the present work was to propose an appropriate instrument or a range of appropriate instruments that enable diverse interventional approaches to be compared, and data quality to be improved. METHODS: A systematic literature search was conducted to map the currently existing measuring instruments. In addition, based on structured interviews with leaders of existing early intervention projects or representatives of other interventional approaches, knowledge and application of the measuring instruments in Germany were determined. In the context of a working meeting, a recommendation was formulated based on the results of the literature search and interviews. RESULTS AND COMMENTS: There is currently no instrument that could be recommended without reservation for the stated purpose. Based on the results of the literature search and the interviews, the working group recommends using, as a first step, the Work Ability Index (WAI, focus on work ability) and the Work Productivity and Activity Impairment Questionnaire (WPAI, focus on absenteeism and presenteeism). German-language versions of both questionnaires are freely available and offer a good compromise in terms of psychometric quality criteria, as well as of practicality and applicability. The measuring instruments should be developed further, with the goal of establishing an optimized instrument that combines the strengths of the two instruments. CONCLUSION: In Germany, use of WAI and the WPAI in as many early intervention approaches as possible will help improve the database, allowing better comparability. However, the focus of further research must be to develop an optimized instrument from elements of WAI and WPAI, in order to be able to measure ability to work as well as the effects of an intervention on preservation or restoration of the ability to work, regardless of the setting.

[Hybrid operating rooms versus conventional operating rooms : Economic comparisons in vascular surgery using the example of endovascular aneurysm repair]. / Hybridoperationssaal vs. konventioneller Operationssaal : Betriebswirtschaftliche Gegenüberstellung in der Gefäßchirurgie am Beispiel der endovaskulären Aneurysmachirurgie.

BACKGROUND: With changing treatment modalities in vascular surgery towards incorporating more endovascular solutions, increased numbers of hybrid operating theatres are being introduced to meet the sterility and imaging quality requirements. These cost-intensive acquisitions however have never been evaluated from an economic perspective. In this study we evaluated cost-relevant parameters before and after the introduction of a hybrid operating room using the example of endovascular aneurysm repair (EVAR) performed in patients with abdominal aortic aneurysms (AAA). METHODS: Retrospective analysis of prospectively collected data. The 4­year period before the introduction of a hybrid operating room were compared with the 4­year period following introduction. Between 2007 and 2010, 97 EVAR procedures were performed before the implementation of a hybrid operating room and 50 EVAR procedures were performed with a hybrid operating room (2012-2015). We evaluated process cost-relevant parameters (operating time) and diagnosis-related group (DRG) parameters (case load, case mix, case mix index). RESULTS: The operating time was significantly reduced on average by 23.5 min (120 min [102-140] vs. 96.5 min [90-120]; p < 0.0001) with a hybrid operating room. This led to a reduction in costs of 276.17 EUR for an EVAR procedure. The case load of EVAR increased from 308 cases from 2007-2010 to 380 cases from 2012-2015 . The associated case mix also increased from 1580 to 1986 points. The total number of case mix points of all managed operative interventions in the operating theatre before and after conversion to a hybrid operating room grew significantly by 17.33% from 8420 to 9880 (p < 0.03) in the compared time periods. CONCLUSION: With detailed, demand-oriented planning, a hybrid operating room can have a favourable economic effect due to a reduction of operating time and the overall lowering of process costs. Thus a refinancing in the long-term is feasible. In addition, this can lead to an increase in the total number and complexity of endovascular procedures.

[Cost and Income Analysis of the 10 Most Frequent Angiography Interventions at a German University Hospital]. / Analyse von Kosten und Erlösen der 10 häufigsten angiografischen Interventionen bei einem Krankenhaus der Maximalversorgung.

Aim: Our aim was to make a detailed evaluation and cost analysis of the 10 most frequent angiography interventions in outpatients and inpatients at a university hospital. Material and Methods: Based on a detailed process-oriented model we calculated the cost and income for port and dialysis catheter implantation, PTA at the upper (UL) and lower leg (LL), TACE, SIRT, stent angioplasty (pelvis, visceral and supra-aortal vessels) and cerebral coil embolisation for the situations mentioned above. Various income models (DRG, GOÄ) were considered. A comprehensive evaluation of the overhead and personnel costs was performed. Results: The calculated data (in €) were as follows (overall, material, personnel costs, DRG income, GOÄ income inpatients, outpatients): port catheter: 375, 266, 59, 328, 260, 612; dialysis catheter: 456, 349, 59, 272, 343, 807; PTA UL: 595, 445, 99, 1 240, 425, 1 077; PTA LL: 732, 552, 129, 1 082, 425, 1 184; stent pelvis: 1 523, 1 338, 135, 1 323, 815, n/a; stent visceral: 2 124, 1 875, 199, 1 326, 912, n/a; stent supra-aortal: 1 901, 1 713, 138, 6 705, 1 138, n/a; TACE: 1 359, 1 120, 188, 2 588, 598, n/a; SIRT: 1 251, 1 054, 147, 2 289, 1 107, n/a; intracranial embolisation: 6 684, 6 367, 266, 6 531, n/a, n/a. Conclusion: Depending on the income model applied, most procedures caused a deficit, especially using GOÄ calculations. Outpatients covered by the private health insurance caused earnings for the procedures applied. Only TACE, SIRT and stent angioplasty of supra-aortal vessels caused profits in inpatients using InEK calculations.

The German and Japanese health care systems: an international comparison using an input-output model.

OBJECTIVES: The German and Japanese health care systems have common roots, but have evolved differently. Whereas the German system is often considered as expensive and poorly efficient, people in Japan are viewed as healthy and health care as comparatively cheap. In this study, we compared the quality, the effectiveness and efficiency of the German and Japanese health care systems. STUDY DESIGN: This study includes comparative health care data analysis. METHOD: The quality and effectiveness of the German and Japanese health care systems were analyzed using an input-output model including 12 countries based on health indicators published by the OECD. Besides the invested resources, a risk-related input dimension was used for risk adjustment. The efficiency of the systems was assessed by relating the average output to the health expenses per capita. RESULTS: Health risks seem qualitatively different in Germany and Japan, but at the aggregate level, lifestyle does not seem to be an outstanding explanatory factor for health outcome differences between both countries. For investments in health resources, Germany is in a top position, whereas in the international comparison, the outcome is rather poor. The resources invested in Japan are also high, but slightly less than in Germany, whereas on average, the outcome is better. However, in the international comparison, resources as well as results in Japan show a very high variability. Relating the average output to the health expenses per capita indicates that on the average, the health care system in Japan is more efficient than in Germany. CONCLUSION: Germany and Japan have a quality problem with their health care systems. In Germany there is a transmission failure from structural to outcome quality that might be related to coordination problems between the outpatient and inpatient sector. Japan shows an unbalanced system that may be suspected to have a quality problem as a whole. As the development of the remuneration system including quality requirements is under the direct responsibility and guidance of the Ministry of Health in Japan, the issue might however be more easily solved in Japan than in Germany. Although on average, health care seems more efficient in Japan than in Germany, taking into account health as well as long-term care expenses and uncertainties related to exchange rate adjustments, the higher efficiency of the Japanese system becomes questionable.

Increasing Liability Premiums in Obstetrics - Analysis, Effects and Options.

Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patients' Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance - Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of one's own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current study data more closely. Among the many solutions which have been proposed, such as the development of quality management, risk management and prevention, better remuneration, a waiver on recourse claims by social insurance underwriters, a cap on damage costs of liability insurers, state liability, an indemnity fund, a system change to Medical Treatment Risk Insurance, as well as a discussion on whether or not it makes sense to use non-clinical obstetrics for the prevention of a further increase in premiums, not one stands out as being especially convincing. On the contrary, a meaningful coordination of various concepts should follow. What seems sensible is a higher remuneration per birth, taking into account the liability premiums as well as, in the medium term, the establishment of a liability fund which, from a certain limit upwards, steps in as liable third party.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

[Health technology assessment (HTA). Developments in healthcare and potential for radiology]. / Health Technology Assessment (HTA). Entwicklung im Gesundheitswesen und Potenzial in der Radiologie.

CLINICAL/METHODICAL ISSUE: Cost-intensive measures and procedures, such as also employed in radiology, have far-reaching economic implications in respect to increasing expenditure with limited resources. STANDARD RADIOLOGICAL METHODS: Health technology assessment (HTA) describes the systematic evaluation of medical procedures and technologies which in recent years has been introduced by many countries into healthcare politics. ASSESSMENT: In many cases HTA analyses can be directly implemented into practice as shown by the examples given in this article; however, in the current form of HTA the practical implementation for radiology often presents the problem that the cost-benefit ratio does not yet have a comprehensive view in the HTA report but is limited to a subsection, e.g. current costs versus sensitivity of a method. Since its inception radiology has had a high power of innovation and new developments will also substantially determine the future years. These procedures must not only be evaluated with respect to feasibility but also in the sense of the HTA in the total concept. PRACTICAL RECOMMENDATIONS: In radiology there are also a large number of possibilities for radiologists not only as passive consumers of HTA reports but also to become active participants in this process, an opportunity which should be taken advantage of.

[Development and implementation of an integrated care pathway at the POLIKUM health centers using the example of anemia]. / Entwicklung und Umsetzung eines integrierten Behandlungspfads in den POLIKUM-Gesundheitszentren am Beispiel der Anämie.

BACKGROUND: Integrated treatment pathways are an appropriate means for increasing the quality of treatment and outcome via process optimization. Taking the POLIKUM Health Centers as an example, we intend to demonstrate how the implementation can be effected for the indication of anemia. METHOD: The development and implementation were executed by an interdisciplinary workgroup in several workshops. In addition, the diagnoses and hemoglobin values of all patients with requests for hemograms were obtained and analyzed at two locations. RESULTS: Developing the pathway required significantly greater efforts than initially planned. The biggest challenge was to adequately map the complexity of the different forms of anemia and, concomitantly, to design a pathway that can actually be realized in everyday life. Moreover, evaluation of the patient data demonstrated that there are a large number of cases where existing anemias are not reflected in the respective diagnoses. CONCLUSION: While the ultimate effects of the new pathway cannot yet be assessed conclusively, it was possible to obtain valuable findings for practical use even at this point. Despite the limitations of the sample, the surprisingly high number of undetected anemias should give physicians cause for taking diagnostic measures even in patients with mild anemia.

[Mechanics and effects of European reference pricing for vaccines in Germany according to §130a Abs. 2 SGB V: an analysis using the example of influenza vaccines]. / Funktionsweise und Auswirkungen des Referenzpreissystems bei Impfstoffen nach §130a Abs. 2 SGB V: eine Analyse am Beispiel der Grippeimpfstoffe.

OBJECTIVES: On 01 January 2011 the bill for the reorganisation of the pharmaceutical market became effective. Since that time there is a European reference pricing (ERP) system for vaccines in order to bring down the German vaccine prices to an assumed lower European level. This study describes the implementation, functioning and effect of this new system. For influenza vaccines the impact of ERP on the price level and spread of prices is analysed. METHODS: The description of the mechanism is based on the law and corresponding regulations of the head association of sickness funds (GKV-SV). The analysis of vaccine prices is based on the data of the i:data report (status of 01 September 2011) of ifap Service Institute. RESULTS: The European reference price is calculated as the average price of the manufacturer-selling-prices of the corresponding vaccine in the 4 countries of the European Union whose gross national income comes closest to the German one and in which the vaccine is distributed. The relied prices are weighted by sales and purchasing power parities of the respective countries. This analysis suggests that in particular the practical implementation of the reference price system should be further improved and specified. The calculation of the reference prices should ensure price comparability. In addition, significant problems remain in the deduction of discounts, because no distinction is made in the documentation of vaccinating doctors, whether vaccination was performed as a compulsory or statutory benefit. The comparison of the manufacturer-selling-prices of individual influenza vaccines with the corresponding reference prices shows an enlargement of the existing price differences, which have evolved in a competitive environment, after the implementation of the reference pricing -system. CONCLUSIONS: There is still a need for improvement in implementing the reference pricing system. In the most competitive vaccine market of influenza vaccines, the ERP-system lowers the prices, but seems to distort the market prices.

[Costs of delivering allogenic blood in hospitals]. / Kosten der Verabreichung von Blutkonserven im Krankenhaus.

INTRODUCTION: In clinical practice there are medical and economic reasons against the thoughtless use of packed red blood cells (rbc). Therefore, in searching for alternatives (therapy of anemia) the total costs of allogeneic blood transfusions must be considered. Using a practical example this article depicts the actual costs and possible alternatives from the point of view of a hospital in Germany. METHOD: To determine the total costs of allogeneic blood transfusions the actual resource consumption associated with blood transfusions was collated and analyzed at the St. Marien-Hospital in Vechta. RESULTS: The authors were able to show that the actual procurement costs (average. 97 EUR) represent only 55 % of the total costs of 176 EUR. The additional expenses are allocated to personnel (78 %) and materials (22 %). Alternatives, such as i.v. iron substitution or stimulation of erythropoesis might be the more economical solution especially if only purchase prices are compared and the total costs of allogeneic blood transfusions are not considered. DISCUSSION: Analyzing a single hospital limits generalization of the results; however, in the international context the results can be recognized as plausible. So far there have been no comprehensive studies on the true costs of blood preparations, therefore, this article represents a first starting point for closing this gap by conducting additional studies.

[Additional qualification in health economics--a pre-condition for ENT leadership positions?]. / Ist eine gesundheitsökonomische Zusatzqualifikation für HNO-ärztliche Leitungspositionen Voraussetzung?

BACKGROUND: The increasing medical-technical progress as well as the dramatic demographic changes cause problems with regard to rapid enlargement of medical service offers, allocation of resources and a financing shortfall in the German public health system. The economization in the German Health System can also be perceived in ENT departments. MATERIAL AND METHODS: After performing an internet search about the rapidly growing market for qualifications measures in health economics, we hence conducted an anonymous survey for ENT senior doctors and directors of the 34 German University Departments to evaluate their attitude towards, as well as their expectation of such an add-on qualification. RESULTS: Since the German government finalized the health care reform in the year 2000 such qualification measures rapidly developed: amongst others, 26 postgraduate, extra-occupational master programs have been inaugurated. The anonymous survey was answered by 105 ENT doctors (63 senior doctors, 27 vice professors and 15 directors). 63% out of these 105 colleagues considered such an add-on qualification to be mandatory. 41% of the colleagues were already "add-on qualified" in that field, only 10 of them by means of a study program. 71 of 105 colleagues (68%) considered the add-on qualification to be advantageous for their future personal career. With regard to the designated contents of the study program, "Staff Management" was even prioritized to "Hospital Financing" and "Cost Accounting". CONCLUSION: Aspects of management and a (health-) economical basic knowledge became an integral part of the daily routine for "first-line management doctors" also in (University) ENT-departments.