As a result of reforms by Health Minister Jens Spahn, new laws will come into force on 1. January 2019 in the areas of health and care.
On the one hand, the contribution to long-term care insurance will rise to 3.05 percent and for childless persons to 3.3 percent. At the same time, the contribution to statutory health insurance will again be divided equally between employers and employees as well as pensioners and pension insurance. This also includes the additional contribution of the health insurance funds, which was reduced by 0.1 percentage points to 0.9 percent in the new year.
On the other hand, hospitals must comply with lower limits for nursing staff in the areas of intensive care medicine, geriatrics, cardiology and accident surgery. In addition, 13,000 jobs will initially be created for nursing care in nursing homes, which will be paid for by the health insurance funds. In addition, each additional position in hospital care will be refinanced by the health insurance funds. The additional costs are also financed by the health insurance companies due to higher tariff agreements. In addition, standard wages for domestic nursing care must be accepted by the health insurance funds.
The new law is intended to make training places more attractive again. Starting in 2019, the remuneration of trainees in their first year of training will be completely covered by the health insurance funds. This applies to children's nursing, nursing and nursing assistance.
In order to make the nurse profession more interesting again, the working conditions are to be improved. In addition to better remuneration, this includes above all the compatibility of work and family life. To this end, nursing homes and hospitals are now being financially supported. In addition, the health insurance funds will have to raise an additional 70 million euros for workplace health promotion.
In order to promote digitization, the nursing insurance funds are releasing 12,000 euros per institution on a one-off basis.
From this year onwards, easier access to inpatient medical rehabilitation services will be guaranteed to relieve the burden on caring relatives. If the person in need of care is cared for in a rehabilitation facility, the health insurance funds will cover the costs.
Germany’s Human Genetic Examination Act exists at a paternalistic extreme of the spectrum with respect to the regulation of genetic services and information, sharing that space with the similarly restrictive Norwegian Biotechnology in Human Medicine Act (pdf), both of which seem influenced by the Council of Europe’s Convention on Human Rights and Biomedicine. Elsewhere on the spectrum, the most comprehensive piece of U.S. federal genetic legislation, the Genetic Information Nondiscrimination Act (GINA), restricts use of genetic information by insurers and employers but leaves individuals free to use genetic testing services as they choose. Similarly, in the United Kingdom, the recent and widely-discussed House of Lords Report on Genomic Medicine advises the DTC genetic testing industry to adopt a voluntary code of conduct for assessing the clinical utility of its services and the need for associated genetic counseling.
The German Act, on the other hand, adopts an extremely protective, even fearful, view of genetic information as something so dangerous and private that the generation and disclosure of genomic data must be mediated solely through specially trained physicians, accompanied by psychological and social counseling, and subject to destruction of the data at any time upon the request of the subject individual. In addition to tightly regulating the doctor/patient relationship, the Act appears intended to outlaw (or at least highly restrict) DTC genetic testing services. One of the laudable purposes of the act, “to protect human dignity and to ensure the individual right to self-determination via sufficient information,” is belied by provisions of the Act that restrict the ability of individuals to access their own genetic information directly.
Assuming the legislation is enacted, there will be plenty of international observers tracking the consequences of Germany’s attempt to tightly control its citizens’ access to and use of their genetic information. Will DTC companies cease sending spit kits to German residents? Will German citizens seek genetic testing in less restrictive climes? Will Germany’s example prompt other countries to follow a similar policy of genetic exceptionalism enforced by paternalistic regulation?
A recent study focused on the Digital Health Index and the index shows how much a country relies on digital technologies in its healthcare system by international standards. The result shows that Germany is lagging behind.
With an index of 30 on a scale of 1 to 100, Germany ranks 16th out of 17 countries surveyed. Only Poland is worse with an index of 28.5. Estonia places the highest emphasis on digital technologies (81.9), followed by Canada (74.7), Denmark (72.5), Israel (72.4), Spain (71.4) and NHS England (70.0). Australia (57.3), Italy (55.8), Belgium (54.7), Switzerland (40.6), France (31.6), Germany and Poland are below the average of 58.9.
The study points out that more emphasis should be placed on the potential of digital health solutions. For example, electronic patient records could prevent dangerous drug interactions, telemedicine could bring patients together with medical experts from any location, and health apps could strengthen chronically ill patients.
"While Germany is still exchanging information on paper and working on the fundamentals of digital networking, other countries are already taking the next steps," said Brigitte Mohn, CEO of the Bertelsmann Stiftung. "In Israel, for example, physicians are systematically using artificial intelligence - for early detection of cancer, for example. The demand from this realization is that health policy must act more decisively and further expand its leading role in shaping digitization for the benefit of patients.
Further recommendations for health policy makers are:
Establishment of a national competence centre:
The coordination of processes from a central location is crucial for successful digitisation. The competence centre should integrate existing institutions, interest groups, experts and users and be responsible for standardising digital applications and defining interfaces. It should be politically controlled and independent of actors' interests.
Step-by-step approach to developments
Individual treatment areas and processes should be targeted. "The expected improvement in care and possible efficiency gains should guide action.
Systematic inclusion of patients and physicians as users:
When developing partial strategies as well as digital applications and processes, users such as patients and doctors should be directly involved and not their professional representatives. The benefits of applications should be visible at an early stage.
Promoting general acceptance:
Digital change needs acceptance and a broadly shared vision. Politicians should understand and approach their communication to this effect as a strategic task.
A published representative population survey commissioned by the digital association Bitkom showed that there is a high level of acceptance for the digital healthcare system. More than two thirds of the respondents were in favor of the use of artificial intelligence in medicine and care.
For the current year, the health insurance funds can show an annual surplus of 1.86 billion euros. With a total of 21 billion euros, the reserves amount to four times the legally prescribed minimum reserve. At the moment there is a heated debate on how to deal with the surplus.
Federal Health Minister Jens Spahn (CDU) demands that contributors participate in the surplus. Doris Pfeiffer, chairman of the board of the GKV Spitzenverband, expresses itself that for 2019 increased expenditures are expected and the average additional contribution was lowered to 0,9 contribution points. At the same time Spahn's statements are criticized also by Green Party and leftists. Maria Klein-Schmeink, health-political spokeswoman of the Green Party, is of the opinion that the high reserves were obtained by the good economic situation and these will be used up again in the future by new laws. Achim Kessler of the left sees the surplus in the improvement of the supply. Georg Baum, Managing Director of the German Hospital Society (DKG), demands that the money should be used to pay the unpaid or uncharged case accounts. Currently, the number of unpaid bills amounts to 20 percent.
In comparison, according to BMG, revenues of 180.6 billion euros were generated in 2017. Expenditure amounted to 178.7 billion euros. The general local health insurance funds (AOK) have a remarkably high surplus of 920 million euros. On the other hand, the surplus of the substitute funds (534 million) and the company funds (190 million) seems rather low.
During the American Heart Association’s Scientific Sessions 2018, Eko, a cardiac monitoring company that combines non-invasive sensors with machine learning presented a clinical study abstract revealing their murmur detection algorithm outperformed the majority of participating cardiologists. The study entitled, “Artificial Intelligence Detects Pediatric Heart Murmurs With Cardiologist-Level Accuracy,” demonstrates the power of machine learning and AI to enhance cardiac care.
80% of Common Cardiac Events are Misdiagnosed
On average, internal medicine and family practice physician residents misdiagnose 80 percent of common cardiac events, according to a study published in the Journal of the American Medical Association. Cardiologists, on the other hand, can effectively diagnose 90 percent of cardiac events using a stethoscope.
AI Algorithm for Heart Murmur Detection
The neural network AI algorithm was trained on thousands of heart sound recordings. The algorithm was then tested on an independent dataset of pediatric heart sounds and compared to gold-standard echocardiogram imagery. Five pediatric cardiologists also listened to the heart sound recordings and independently made a determination whether a recording contained a murmur. This advancement will help narrow the clinical skill gap between the 27,000 cardiologists in the U.S. – the experts at murmur detection – and the 3.8 million other clinicians who are less experienced in the identification of heart murmurs through a stethoscope.
“When it comes to healthcare, data almost always leads to better results because practitioners are able to make more informed decisions,” said Dr. Nicholas Slamon, Pediatric Critical Care Physician at Nemours Children’s Health System. “Eko’s technology is leveraging the largest available dataset of previously captured heart sounds to elevate the skills of clinicians and in turn provide guidance on how to diagnose, and subsequently treat serious, often fatal cardiac conditions. It’s a powerful advancement for the world of medicine.”
FDA Clearance for the Algorithm
Eko’s murmur screening algorithm, when coupled with the company’s FDA-cleared Eko Core and Eko DUO devices, will enable any and all clinicians to more accurately screen for heart murmurs. Eko is currently pursuing FDA clearance for the algorithm and will be rolling it out with its existing cardiac monitoring devices upon securing regulatory clearance.
By European Society for Medical Oncology
A study conducted in Germany draws attention to the fact that the socio-economic burden of cancer is real in Europe too, and not only in the context of the US healthcare system where it has been associated with higher morbidity and mortality. The results to be presented at the ESMO 2018 Congress in Munich show that income loss is the main source of perceived financial hardship, and that this is associated with adverse psychological effects in patients.
The work also highlights the absence of clear definitions and valid instruments with which to examine this issue. Prof. Eva Winkler, study author, medical oncologist at the National Centre for Tumour Diseases (NCT) in Heidelberg, explained the background: "We conducted a systematic literature review of the tools used to measure the subjective financial burden of cancer patients: of the 39 studies we found, most came from the USA, and the instruments they used were either not transferrable to the German context or not sufficiently focused on the subject," she said.
Study co-author Dr. Katja Mehlis from the NCT added: "We were, however, able to identify three broad dimensions through which subjective financial burden could be assessed: material aspects, psychological effects and behavioral changes such as support seeking and coping strategies. Based on this, we developed our own, yet non-validated set of questions covering income, cancer-related out-of-pocket costs, distress and lifestyle changes."
A total of 247 patients, 122 diagnosed with neuroendocrine
tumors and 125 treated for colorectal cancer, responded to the survey between November 2016 and March 2017. The results brought to light financial impacts in a significant proportion of patients: 80.6% of respondents stated that they faced higher out-of-pocket costs related to their illness.
Although most medical costs in Germany are covered by a person's health insurance, patients do have to contribute co-payments for prescription drugs. Cancer patients may additionally face travel expenses to get to the hospital or medical centre, as well as potentially having to pay for care, housekeeping or childcare. For over three quarters of the patients who responded to the survey, disease-related out-of-pocket costs amounted to less than 200 euros monthly.
Cancer-related income loss was reported by 37.2% of survey participants. "In our study, this effect was more serious than out-of-pocket costs, as the suffered losses exceeded 800 euros per month in almost half of cases. They were mainly due to patients being unable to work or forced to reduce their working hours," said Mehlis.
Bain’s 2018 Europe Front Line of Healthcare Survey reveals an industry facing serious challenges, but lacking a clear path forward.
By Bain & Company
In the two years since we last surveyed physicians working on the front line of European healthcare, their discontent has risen to an alarming level. Many say they would not recommend their hospital as a place to work or to receive care. Physicians and surgeons also have grown increasingly dissatisfied with pharma companies and medtech manufacturers over the past two years.
Citing staffing shortages, budget cuts, aging equipment and inadequate facilities, physicians warn they are unprepared to cope with looming healthcare challenges, including aging populations and the reemergence of infectious diseases (see Figure 1). In addition to inadequate resources, physicians also cite a lack of unbiased information, which impedes sound decision making. More than 70% say they are dissatisfied with the information pharma and medtech companies provide.
Read full report on Bain's Website
Telemedical network speeds treatment for stroke patientsDoctors in Germany are conducting long-term tests of innovative telemedical and therapy options for treating stroke patients as quickly as possible. Among the approaches being investigated and refined are mobile stroke units, known as STEMO, and TEMPiS or the "flying interventionalists."
TEMPiS stands for TeleMedical Project for Integrated Stroke Treatment. It involves specialized, primarily urban stroke therapy centers and at least 11 regional hospitals in southeastern Bavaria, a digital network, stroke experts – and helicopters to get the professionals to where they are needed. Program initiators say TEMPiS is unique to Germany and is the world's largest telemedical stroke network as well.
Time is vital in treating stroke patients. STEMO diagnosis and treatment starts while stroke sufferers are on the way to the hospital. Its main aim is to determine if a stroke has indeed occurred. If so, thrombolysis may be used to dissolve the clots causing the stroke. Studies have indicated that patients in the STEMO program are six times more likely than other patients to receive therapy vital to nerve cell survival within the first hour of treatment.
If thrombolysis fails surgery to remove the clot, known as a thrombectomy, may be required. Rather than bringing a patient to the city for treatment, the TEMPiS system works to ensure that experienced and specialized neuroradiologists are flown by helicopter to perform the surgery at one of eleven regional hospitals. Before they even arrive, patients are being prepared. The "interventionalists" and their teams use video conferencing and telemedical transmissions of CT images to coordinate and speed their efforts. Researchers have found that compared to conventional ambulance services, the TEMPiS system shortens the time it takes for a patient to receive treatment by well over an hour.
Doctors in Bavaria have been gathering a broad range of data on the system since its inception in 2003. Currently, the state health insurance industry is financing a trial in which the "flying interventionalists" are available for 26 weeks of the year. Otherwise, stroke patients will be taken to treatment centers in an ambulance. After six months, an interim assessment will be made.
If the results show that TEMPiS brings improved outcomes, the system could certainly be applied outside of Germany as well. In places with far flung populations, such as Australia, Saudi Arabia, Canada, or parts of the US, the innovative system devised in Germany could bring life-saving treatment to stroke victims.