11th UK Stroke Forum Conference Liverpool, September 29 th 2016

11th UK Stroke Forum Conference Liverpool, September 29th 2016 What have we learnt from Germany? Peter Hermanek, Munich Agenda   European healt...
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11th UK Stroke Forum Conference Liverpool, September 29th 2016 What have we learnt from Germany?

Peter Hermanek, Munich

Agenda 



European health care systems Strategies for quality assurance in hospital care in Germany



ADSR



Results from the bavarian registry

European health systems Beveridge System = financed by taxes

vs. Bismarck System = financed by (social) insurance

Bismarck

Beveridge

Proportion of income spent for the social care system in Germany 2015 

Pension funds

19.9%

limit 66.000 €



Unemployment funds

2.8%

limit 66.000 €



Health care

14.9%

limit 45.000 €



disabled care

1.95%

limit 45.000 €

total 39.55%

Economic data 2013 





 

 

Gross domestic product per head (Germany) Health care costs per head (Germany) UK Italy Sweden Germany France

8.5% 8.8% 11.0% 11.0% 10.9%

43 809 $ 4 819 $ Poland USA

www.oecd.org

6.4% 16.4%

Health care system in Germany



Inpatient care



Outpatient care

Health care costs Germany 2013 

11.0% of gross domestic product

314.9 Billion €



inpatient care

82.4 Billion €

Proportion of inpatient care costs 2013

    

UK Spain USA Germany France

n. a. 23.1% 24.7% 25.0% 25.2%

Poland

31.0%

Canada

14.6%

www.oecg.org

Basic data 2014 Germany 82.175.684 Inhabitants 

acute hospitals total

1 980

general hospitals (incl. university hospitals) psychiatry/neurology hospitals



1 646 334

prevention and rehabilitation hospitals 1 158

1 980 acute hospitals 

public

589

(30%)



denominational

696

(35%)



private

695

(35%)

500 680 beds

Hospitals 2014 Germany



1 103 562 employees 175 207 medical doctors 422 779 nurses

Health Care in Germany



mandatory health insurance (99% of the population)



free access



no waiting lists (so far)

Challenges 

Demography:

Proportion of people over 60 years

1950: 1970: 2001: 2030:

15% 20% 24% 34%

Social Law 

hospitals must introduce quality management



standards of quality (structure, results)



mandatory structured quality reports

§135a german social law 



.... hospitals must systematically ask for their own quality of care and take efforts towards continous improvement (PDCA - cyclus) .... a management method based upon efforts of all persons working in hospital independant from classic hierarchies

quality reports  





treatment data quality data (structure und results)

health insurances must publish reports via internet health insurances can make rankings and recommendations for patients, public ...

Stroke incidence in Germany



 

82.175.684 inhabitants 196 000 strokes first-ever 66 000 recurrent strokes

Kolominsky-Rabas et al., Stroke 1998; 29: 2501-06

Outcome 

responsible for 8% of deaths



third most frequent cause of death



most frequent cause of severe disability (25% of survivers with Barthel