Background of National Quality Policy

1. Background of National Quality Policy Workshop 1 ENQual Programme NIVEL, Utrecht 28.11.2003 G. Ollenschläger 1 G. Winker-Komp, C. Thomeczek 1 1 German Agency for Quality in Medicine AQuMed (Joint Institution of GMA and NASHIP, Cologne) 2 German Ass. for Quality Assurance in Health Care

2. Outline Germany – Some background information Quality in health care – an actual topic in Germany Health care reform 2003 and quality

3. Source: Statistics Division and Population Division of the United Nations Secretariat

4. Structure of the German Social Security System Achberger 2000

5. German Health Care SystemBasic Features • Statutory Social Health Insurance System • covers about 90% of population • Principle of Solidarity • financial contributions differ • equal benefits to all insured • Pluralism • Federal government, state governments, self-regulating corporate bodies • Delegation of power to non-governmental corporate bodies • Providers Associations • Sickness Funds Associations Marcial Velasco Garrido, 2002

6. Who defines the Benefit Catalogue? Possible Health Benefits Marcial Velasco Garrido, 2002 German Parliament Service Framework Federal Standing Committee of Physicians and Sickness Funds Benefit Catalogue Medical Review Board of the Sickness Funds Sickness Funds Social Courts

7. Health Insurance Systems in Germany Achberger 2000

8. German Network of Quality Agencies (Owned / sponsored by Self Governing Partners) RV BÄK KBV GKV PKV DKG AWMF DPR BMG Agency for Quality in Medicine KTQ (Cooperation for Transparency and Quality in Healthcare) Committee of Physicians + Sickness Funds Federal Office for Quality Assurance Germ. Assoc. for Quality Ass. in Healthcare Guideline Clearing Accreditation Progr, Disease Manag. Programmes, HTA Quality Assess. in Hospitals Evaluation of Quality Programmes Stobrawa, 2002

9. German Agency for Quality in Medicine AQuMed Steering Group (Representatives of German Medical Association and National Assoc. of Statutory Health Insurance Physicians) GGC Steering Group GMA NASHIP Nat. Hosp. Ass. Statut. Sickn.F. Priv. Insuran.F. Publ.Pension Insur.Funds German Guideline Clearinghouse Patient Information Clearinghouse PIC Steering Group GMA NASHIP Disabled People Ass. Health Care Consum. Ass. Self Help Gr.A. Office for CPG Implementation Center for Evidence Based Medicine Office for Quality Progr. Clearing Task Force Patient Safety – Error Prevention AQuMed Executive Communication, Information Programme Management Research and Development Training, Education Website www.aezq.de Expert Committees & Panels Journ. for CME, Qual.Ass. ZaeFQ Guideline Appraisal Groups Guideline Appraisal Groups Guideline Appraisal Groups Guideline Appraisal Groups Guideline Appraisal Groups

11. Quality problems in Germany ?Where is the evidence ?

12. Problems with the German Healthcare System ? • Deficits in quality, economic efficiency, transparency and patient orientation. • Challenges for health insurance due to aging population, medical progress and changes in people's working lives. • Financing of health insurance, being solely dependent on income, leads to increasing incidental wage costs and therefore to negative effects on the labour market. Press Release, Fed. Government 2003-08-01

13. Outcomes in German Health Care Busse 2002

14. Nurse assessed quality of care, 98/99 Aiken et al, 2001 US CA EN SC DE % confident that their patients are able to manage their own care when discharged 33.8 30.0 59.7 56.1 80.9 % who say the quality of care in their hospital has deteriorated in the last year 44.8 44.6 27.6 21.5 17.2 Busse 2002

15. Total Expenditures on Health- % of GDP - Increasing contribution rates 13,5% to 14,5% (2002) • Source: WHO 2000

16. 2003: the Year of the Reform Goals of the newest health care reform • Stabilise contribution rates • Increase quality and efficiency of care • Develop competitiveness among providers • Strengthen patients rights • Uphold basic principles • Solidarity • equal right to treatment for all insured citizens

17. Stat. Health Ins. Modernisation Act 2003 - Measures Strengthening of patient sovereignty • Patient representative at federal level • Consumer information by Inst. for Quality and Econ. Efficiency in SHI Improving quality of care • Inst. for Quality and Econ. Effeciency in SHI (foundation of self governing partners): assessment of guidelines, recommendations on national disease management programmes, assessment of benefits of medicines, HTA. • Standard quality management for in-patient and out-patient services. • Mandatory CME

18. Assessment Appraisal & Guidance Feedback NICE Dissemination Monitoring Implementation Evidence-Based Practice in Healthcare Identification Littlejohns, NICE NICE – A New Model for Germany ?

19. What about Professional Self-regulation ??? Littlejohns, NICE

20. 1996 1997 1998 1999 2000 2001 2002 Implementation of systematic Quality oriented + Evidence based Healthcare in Germany (by Self Governing Partners) „Evaluation“ Phase Testing, assessment of tools / procedures „Orientation“ Phase Analysis of the international state of the art „Routine“ • Institutionalisation • Guidelines Clearinghouse • Nat. Disease Manag. Programme • HTA for definition of benefits • Quality measure for hospitals • Peer groups for outpat. care • DRG‘s + TQM in hospitals „Development“ Phase Development of methodological standards, networking (international/ national) Perleth & Schwartz 2001, modified

21. Thanks for your patience !!!! • www.azq.de • www.leitlinien.de • www.patienten-information.de • www.g-i-n.net Founder Member