Kopetsch T, Maier W
Kassenärztliche Bundesvereinigung, Dezernat 4 GB Sicherstellung und Versorgungsstruktur, Berlin.
Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Neuherberg.
Gesundheitswesen. 2018 Jan;80(1):27-33. doi: 10.1055/s-0042-100622. Epub 2016 May 12.
A new strategy for planning outpatient medical care needs to be developed. The social and morbidity structure of the population should be considered in the planning of needs-based provision of medical care. This paper aims to examine the extent to which the degree of regional deprivation can be incorporated in the calculation of the regional requirements for specialists in Germany.
To measure regional deprivation status at district level, we used the "German Index of Multiple Deprivation" (GIMD) developed in the Helmholtz Zentrum München - German Research Center for Environmental Health. Scores were calculated for the deprivation status of each rural and urban district in Germany. The methods used to compute the deprivation-adjusted medical need are linear regression analyses. The analyses were based on regionalized data for the number of office-based physicians and their billing data. The analyses were carried out with the SPSS software package, version 20.
The analyses showed a clear positive correlation between regional deprivation and the utilisation of medical services both for outpatients and in-patients, on the one hand, and mortality and morbidity, as measured by the risk adjustment factor (RSA), on the other. At the district level, the analyses also revealed varying associations between the degree of deprivation and the utilisation of the 12 groups of specialists included in the needs assessment. On this basis, an algorithm was developed by which deprivation at district level can be used to calculate an increase or a decrease in the relative number of specialists needed.
Using the GIMD and various determinants of medical utilisation, the model showed that medical need increased with the level of regional deprivation. However, regarding SHI medical specialist groups, the associations found in this analysis were statistically (R) insufficient to suggest a needs assessment planning system based only on the factors analysed, thereby restricting physicians' constitutional right of professional freedom. In particular cases, i. e. licenses to meet special needs, the developed instruments may be suitable for indicating a greater or lesser need for doctors at a regional level due to their relative ease of use and practicability.
需要制定一项规划门诊医疗服务的新策略。在基于需求提供医疗服务的规划中，应考虑人口的社会和发病结构。本文旨在探讨在德国，地区贫困程度在多大程度上能够纳入地区专科医生需求计算中。
为衡量地区层面的贫困状况，我们使用了慕尼黑亥姆霍兹中心 - 德国环境卫生研究中心编制的“德国多重贫困指数”（GIMD）。计算了德国每个农村和城市地区的贫困状况得分。用于计算经贫困调整后的医疗需求的方法是线性回归分析。分析基于基层医生数量及其计费数据的区域化数据。分析使用SPSS软件包20版进行。
分析表明，一方面，地区贫困与门诊和住院患者的医疗服务利用之间存在明显的正相关，另一方面，与通过风险调整因子（RSA）衡量的死亡率和发病率之间也存在正相关。在地区层面，分析还揭示了贫困程度与需求评估中包含的12组专科医生的利用情况之间存在不同的关联。在此基础上，开发了一种算法，通过该算法可以利用地区层面的贫困状况来计算所需专科医生相对数量的增加或减少。
使用GIMD和各种医疗利用决定因素，该模型表明医疗需求随地区贫困程度的增加而增加。然而，对于法定医疗保险的专科医生群体，本分析中发现的关联在统计学上（R）不足以支持仅基于所分析因素的需求评估规划系统，从而限制了医生的职业自由宪法权利。在特定情况下，即满足特殊需求的许可证，由于其相对易用性和实用性，所开发的工具可能适用于表明地区层面医生需求的或多或少。
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