Wiethege J, Ommen O, Ernstmann N, Pfaff H
Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft--eine gemeinsame Einrichtung der Humanwissenschaftlichen und der Medizinischen Fakultät der Universität zu Köln & Zentrum für Versorgungsforschung, Eupener Straße 129, Köln.
Gesundheitswesen. 2010 Oct;72(10):722-8. doi: 10.1055/s-0029-1239567. Epub 2009 Nov 12.
Currently, elements of managed care are being implemented in the German health-care system. The legal basis for these innovations are § 140, § 73, § 137, and §§ 63 et seq. of the German Social Code - Part 5 (SGB V). For the model projects according to §§ 63 et seq. of the German Social Code a scientific evaluation and publication of the evaluation results is mandatory. The present study examines the status of evaluation of German model projects.
The present study has a mixed method design: A mail and telephone survey with the German Federal Social Insurance Authority, the health insurance funds, and the regional Associations of Statutory Health Insurance Physicians has been conducted. Furthermore, an internet research on "Medpilot" and "Google" has been accomplished to search for model projects and their evaluation reports.
34 model projects met the inclusion criteria. 13 of these projects had been terminated up to 30/9/2008. 6 of them have published an evaluation report. 4 model projects have published substantial documents. One model project in progress has published a meaningful interim report. 12 model projects failed to give information concerning the evaluator or the duration of the model projects.
The results show a significant deficit in the mandatory reporting of the evaluation of model projects in Germany. There is a need for action for the legislator and the health insurance funds in terms of promoting the evaluation and the publication of the results. The institutions evaluating the model projects should obligate themselves to publish the evaluation results. The publication is an essential precondition for the development of managed care structures in the health-care system and in the development of scientific evaluation methods.
目前，德国医疗保健系统正在实施管理式医疗的一些要素。这些创新举措的法律依据是德国社会法典第5编（SGB V）的第140条、第73条、第137条以及第63条及以下条款。对于依据德国社会法典第63条及以下条款开展的示范项目，必须进行科学评估并公布评估结果。本研究考察了德国示范项目的评估现状。
本研究采用混合方法设计：对德国联邦社会保险局、医疗保险基金以及法定医疗保险医师地区协会进行了邮件和电话调查。此外，还在“Medpilot”和“谷歌”上进行了网络搜索，以查找示范项目及其评估报告。
34个示范项目符合纳入标准。截至2008年9月30日，其中13个项目已结束。其中6个项目发表了评估报告。4个示范项目发表了大量文件。1个正在进行的示范项目发表了一份有意义的中期报告。12个示范项目未提供有关评估者或示范项目持续时间的信息。
结果表明，德国示范项目评估的强制报告存在重大缺陷。立法者和医疗保险基金需要采取行动，以促进评估和结果的公布。评估示范项目的机构应承诺公布评估结果。公布是医疗保健系统中管理式医疗结构发展以及科学评估方法发展的重要前提。
