Küpper-Nybelen J, Ihle P, Deetjen W, Schubert I
PMV Forschungsgruppe, Universität zu Köln, Herderstr. 52-54, 50931 Köln.
Z Gerontol Geriatr. 2006 Apr;39(2):100-8. doi: 10.1007/s00391-006-0369-3.
In Germany all members of the statutory health insurance are also compulsory members of the nursing care insurance which financially supports nursing care at home and in nursing homes. Benefits are provided dependent on a standardized medical examination performed at the home of the applicants by trained physicians or nurses of the health insurances' medical service (MDK). The benefits are granted to those persons who are limited in the performance of activities of daily living due to physical, cognitive or mental disorders. In the German Code of Social Law regulating the long-term care system, one important entitlement is "rehabilitation before long-term care". It aims at maintaining life of disabled persons in their familiar surroundings as long as possible. Up to now in the nursing care insurance this aim has been implemented insufficiently. The objective of this study was therefore to investigate the frequency of suggested ambulatory rehabilitation, which is recommended by the MDK at the examinations, and the following prescription of ambulatory rehabilitation, issued by an office-based physician. The database included the medical examinations of the years 2001 to 2002 linked to a random sample of persons insured in a statutory sickness fund in the German federal state of Hesse. Nursing care-related information including recommended rehabilitation therapy was derived from the medical examinations. Insurance data provided information on prescriptions. Data of 7,840 persons could be analyzed. Rehabilitative therapy was recommended in 15% of the nursing care applicants, mostly physiotherapy (ca. 90%). Persons receiving the recommendation were mainly male, they were younger, were more disabled, had less often a diagnosis of the ICD-10 chapter "symptoms and abnormal clinical and laboratory findings" or "mental and behavioral disorders", live less often alone and were more restricted in their motion compared to persons without recommendation for rehabilitative therapy. Only 55.3% of the persons with a recommendation for physiotherapy and only one-third with a recommendation for occupational therapy or logopedics received a prescription for the respective therapy in the following three months after examination. The age younger than 80 years, professional care, no home care, and-as the strongest item-preceding therapy were positively related to receiving a prescription. These findings show that disabled persons have the capability for prevention and rehabilitation, but it is used in only half of them. One possible reason might be the financing of the remedies, which burdens the budget of the health insurance, where instead the nursing care insurance benefits from the possible delay of the utilization of nursing care.
在德国，所有法定医疗保险的参保人员同时也是护理保险的强制参保人员，护理保险为居家护理和养老院护理提供资金支持。护理保险福利的提供取决于由医疗保险医疗服务机构（MDK）训练有素的医生或护士在申请人家里进行的标准化医学检查。福利给予那些因身体、认知或精神障碍而在日常生活活动能力方面受限的人。在德国规范长期护理系统的社会法典中，一项重要的权利是“长期护理前的康复”。其目的是尽可能让残疾人在熟悉的环境中维持生活。到目前为止，在护理保险中这一目标尚未得到充分落实。因此，本研究的目的是调查MDK在检查时建议的门诊康复的频率，以及随后由门诊医生开具的门诊康复处方。数据库包括2001年至2002年与德国黑森州一个法定疾病基金的随机参保人员样本相关的医学检查。与护理相关的信息，包括推荐的康复治疗，来自医学检查。保险数据提供了关于处方的信息。对7840人的数据进行了分析。15%的护理保险申请人被建议进行康复治疗，其中大多是物理治疗（约90%）。与未被建议进行康复治疗的人相比，收到建议的人主要是男性，他们更年轻，残疾程度更高，较少被诊断为国际疾病分类第10章“症状及异常的临床和实验室检查结果”或“精神和行为障碍”，较少独自生活，行动受限更严重。在接受物理治疗建议的人中，只有55.3%的人在检查后的接下来三个月内收到了相应治疗的处方，而接受职业治疗或言语治疗建议的人中只有三分之一收到了处方。80岁以下的年龄、专业护理、无居家护理以及——作为最显著的因素——先前的治疗与收到处方呈正相关。这些发现表明，残疾人有预防和康复的能力，但只有一半的人得到了利用。一个可能的原因可能是治疗费用的问题，这给医疗保险的预算带来了负担，而护理保险却可能从护理服务利用的延迟中受益。
