Zum Beitrag der gesundheitsökonomischen Forschung zur medizinischen Versorgung

Zusammenfassung

Die Gesundheitsökonomie kann den optimalen Ressourceneinsatz in der medizinischen Versorgung auf vielfältige Weise unterstützen. Nach einem Blick auf Entwicklungen in der prozessorientierten, morbiditätsbezogenen Steuerung der Krankenhausversorgung stehen Ergebnisse, speziell die Patientenperspektive und Patient-Reported Outcomes im Fokus. Näher vorgestellt werden Messansätze und Auswirkungen präferenz- und erfahrungsbasierter Bewertungen der gesundheitsbezogenen Lebensqualität. Als Basis dienen Bevölkerungsstichproben und routinemäßig erhobene, indikationsspezifische Stichproben. Zum ergebnisbezogenen Value-based Health Care Ansatz wird der Wertbegriff kritisch beleuchtet. Einen neuen Ansatz zur Integration medizinischer und ökonomischer Zielsetzungen bildet das Outcome-orientierte Versorgungsmanagement. Dazu werden Entwicklungstrends, ein Managementzyklus und ein Studienbeispiel behandelt. Outcomes sind ein vielversprechendes Zukunftsthema, mit dem Beiträge der gesundheitsökonomischen Forschung zur medizinischen Versorgung weiter verbessert werden könnten.

Abstract

Health economics can take many approaches to support optimal use of resources in medical care. Following a view upon developments in the process-oriented, morbidity-based regulation of inpatient care, the paper focuses on outcomes, especially on the patient perspective and on patient-reported outcomes. The paper introduces measurement approaches and impacts of valuing health related quality of life, either based on preferences, or on experience. Therefore, it analyzes population samples and routinely collected patient samples. For the outcome-related approach of value-based health care, the paper critically discusses the meaning of value. A new approach to integrate medical and economic aims in health care is outcome-oriented management. Trends in development, a management cycle, and a study example outline the approach. Outcomes make up a promising future topic, by which health economic research may further contribute to medical care.

Schlüsselwörter

Diagnosis-Related Groups - EQ-5D-Wert - outcome-orientiertes Management

Key words

Diagnosis-Related Groups - EQ-5D-value - outcome-oriented management

• Literatur

• 1 Brosig-Koch J, Hennig-Schmidt H, Kairies-Schwarz N. et al. The effects of introducing mixed payment systems for physicians: Experimental evidence. Health Economics 2017; 26: 243-262
• 2 Patel MS, Volpp KG, Rosin R. et al. A randomized, controlled trial of lottery-based financial incentives to increase physical activity among overweight and obese adults. American Journal of Health Promotion. 2018
• 3 Reed ME, Warton EM, Kim E. et al. Value-based insurance design benefit offsets reductions in medication adherence associated with switch to deductible plan. Health Affairs 2017; 36: 516-523
• 4 Fetter RB, Shin Y, Freeman JL. et al. Case mix definition by diagnosis-related groups. Medical Care 1980; 18: i-53
• 5 Vogl M, Warnecke G, Haverich A. et al. Lung transplantation in the spotlight: Reasons for high-cost procedures. The Journal of Heart and Lung Transplantation 2016; 35: 1227-1236
• 6 Vogl M, Schildmann E, Leidl R. et al. Redefining Diagnosis-Related Groups (DRGs) for palliative care – a cross-sectional study in two German centres. BMC Palliative Care 2018; 17: 58
• 7 Duckett S. Aligning policy objectives and payment design in palliative care. BMC palliative care 2018; 17: 42
• 8 Schumm-Draeger P-M, Mann K, Müller-Wieland D. et al. Der Patient ist kein Kunde, das Krankenhaus kein Wirtschaftsunternehmen. DMW-Deutsche Medizinische Wochenschrift 2016; 141: 1183-1185
• 9 Kifmann M, Siciliani L. Average-cost pricing and dynamic selection incentives in the hospital sector. Health Economics 2017; 26: 1566-1582
• 10 Codman E. The product of a hospital. Surg GynecolObstet 1914; 18: 491-496
• 11 Hicks CW, Makary MA. A prophet to modern medicine: Ernest Amory Codman. BMJ: British Medical Journal (Online) 2013; 347
• 12 Northwestern University. Health Measures. http://www.healthmeasures.net/index.php 03/2018
• 13 Porter ME, Larsson S, Lee TH. Standardizing patient outcomes measurement. New England Journal of Medicine 2016; 374: 504-506
• 14 Karimi M, Brazier J, Paisley S. How do individuals value health states? A qualitative investigation. Social Science & Medicine 2017; 172: 80-88
• 15 Ludwig K, von der Schulenburg J-MG, Greiner W. German value set for the EQ-5D-5 L. PharmacoEconomics. 2018
• 16 Leidl R, Reitmeir P. An experience-based value set for the EQ-5D-5 L in Germany. Value in Health 2017; 20: 1150-1156
• 17 Devlin NJ, Shah KK, Feng Y. et al. Valuing health-related quality of life: An EQ-5D-5 L value set for England. Health Economics 2018; 27: 7-22
• 18 Versteegh MM, Vermeulen KM, Evers SM. et al. Dutch tariff for the five-level version of EQ-5D. Value in Health 2016; 19: 343-352
• 19 Olsen JA, Lamu AN, Cairns J. In search of a common currency: A comparison of seven EQ-5D-5 L value sets. Health Economics 2018; 27: 39-49
• 20 Pickard AS, Hung Y-T, Lin F-J. et al. Patient experience-based value sets: Are they stable?. Medical Care 2017; 55: 979-984
• 21 Nemes S, Burström K, Zethraeus N. et al. Assessment of the Swedish EQ-5D experience-based value sets in a total hip replacement population. Quality of Life Research 2015; 24: 2963-2970
• 22 Decker S, Schmitz H. Health shocks and risk aversion. Journal of Health Economics 2016; 50: 156-170
• 23 Norman R, Chalkidou K, Culyer AJ. A health economics approach to US value frameworks: Serving the needs of decision making. Value in Health 2018; 21: 117-118
• 24 Lee VS, Kawamoto K, Hess R. et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. Journal of the American Medical Association 2016; 316: 1061-1072
• 25 Rose S, Bergquist SL, Layton TJ. Computational health economics for identification of unprofitable health care enrollees. Biostatistics 2017; 18 (04) 682-694