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Background: Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with a focus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest., Objectives: This paper aims to illustrate how VBHC principles are currently being implemented in the field of internal medicine in Germany and to identify the potential that can be derived from VBHC pioneering examples from the Netherlands., Materials and Methods: Selected case studies are presented to illustrate how VBHC principles are already being applied in internal medicine, focusing on where PROMs are utilized and how value-based reimbursement supports VBHC implementation-both in Germany and the Netherlands., Results: In Germany, various cross-provider initiatives and individual providers implement the VBHC element of PROMs measurement. In addition, the Baden-Württemberg selective contract in cardiology demonstrates how financing VBHC elements in regular care was already made possible in Germany. Pioneers such as the Dutch center of excellence Diabeter and the multidisciplinary care network Netherlands Heart Network provide further inspiration for the implementation of VBHC in internal medicine., Conclusion: While various initiatives support the measurement of PROMs in the German context, the use of these results in care practice is not apparent. The utilization of PROMs and strategies identified in Dutch examples could be initial steps toward fostering VBHC in Germany., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background  There is an ongoing discussion within the German Society of Internal Medicine (DGIM) and the Professional Association of German Internists (BDI) about the appropriate depiction and remuneration of internal medicine in the G-DRG. Method  Therefore, cases with a significantly prolonged length of stay were analyzed in a multicenter study. 124 cases from 6 hospitals were collected for evaluation. Results  The results show that the observed prolongation of hospitalization was mainly due to medical reasons. Discussion  Thus, patients with unclear symptoms and consequently need for a thorough workup could not be identified to cause longer inpatient stay. Instead, treatment complications and comorbidities led to extended hospitalization. The results also reveal prolonged hospitalization as a consequence of unsettled or delayed postdischarge care e. g. in rehabilitation facilities., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The treatment of patients with dementia in acute care hospitals is becoming increasingly more important. The aim of this study was to investigate and demonstrate aspects of the healthcare situation and resource consumption of dementia patients during their hospital stay in a ward for internal medicine., Material and Methods: Secondary data from a ward of internal medicine were analyzed on a retrospective and case-related basis. For 100 patients a diagnosis of dementia by a general practitioner before hospitalization was identified. The control group was selected by age and sex from the other patients in the ward (n = 100). The costs were calculated on the basis of the German diagnosis-related groups (G-DRG) flat rate case classification. The relationship between dementia, deviation from the average length of stay and costs was investigated under the control of comorbidities using multivariate regression analysis., Results: Patients with dementia had poorer health at admission with respect to functionality and orientation and a higher risk of falls and pressure ulcers. During hospitalization patients with dementia fell more frequently than patients without dementia (12 % versus 3 %, p = 0.029). Regarding the average length of stay, according to the G‑DRG catalogue patients with dementia stayed 1.4 days longer in hospital than patients without dementia and caused excess costs of 19 %., Conclusion: Patients with dementia are a highly vulnerable patient group with a higher consumption of resources than patients without dementia. The results demonstrate the care-related and economic consequences, which the increasing number of patients with dementia could have in the future.

The booming cruise industry, associated with ships with more passengers and crew on board, results in growing medical needs for the ship doctor. The ship's doctor insurance policy includes different jurisdictions, namely national law, international law, tort law, insurance law and labor law. In addition, international agreements must be taken into account, which complicates the design of an adequate insurance policy. Equally high are the costs and defense costs for the ship's doctor in case of liability. In order to limit the liability for all parties is to ask for appropriately qualified medical staff, hired on board., (© Georg Thieme Verlag KG Stuttgart · New York.)

The article shows which patients are in need of palliative care, what the objectives are and that medical care, at the place of the patient's own choice, should be provided. The structures of palliative care in Switzerland and in the region of Schwyz are presented and explained in detail. The difficulties of the financial aspects of palliative care patients in the DRG-system are pointed out. Furthermore, focus is put on the different problems of palliative care from a hospital doctor's point of view. These are, funding, politics, chirurgical colleagues at the hospital, misjudgment of capabilities and capacities of all people involved in palliative care (doctors and nursing staff in and as well as out of a hospital setting), their lack of knowledge in the treatment of symptoms, insufficient communication and coordination of the care-staff of various professions, no guarantee of complete twenty-four-hour care of patients and the lack of standardization in the final phase of terminal care according to the guidelines of Liverpool Care Pathway in all institutions and at home.

Background and Purpose: Practicing doctors are managers of their own practice. A doctor, who manages his practice besides his technical qualification, considering business aspects, enables a solid economic base. The objective of this article is to point out key starting points for an effective management of internist doctors' practices., Material and Methods: Within the article it has particularly been analyzed, to what extent cooperations make an impact on the return and cost structure. For this purpose, a total of 495 business assessments from the DATEV eG of internist doctors' practices have been analyzed., Results: The percental returns of smaller internistic joint practices (averaged turnover: 573,071 Euros) is about 6% higher than the percental returns of internistic doctors' practices (averaged turnover: 384,049 Euros). This result shows that small internistic joint practices work more efficiently. In contrast to this result bigger joint practices (averaged turnover: 1,618,608 Euros) gain an about 6% lower percental return than internistic doctors' practices. The reasons for this result are, compared to the internistic doctors' practices, the higher consumption of materials (+7%), the higher personnel costs (+3.5%), and the higher occupancy costs (+0.2%). On the basis of these results it can be concluded, that medium-sized internistic joint practices work more efficiently than internistic doctors' practices as well as large internistic joint practices., Conclusion: On the basis of the results it can be concluded, that internist cooperations can make good economic sense. However, the extent of cost efficiency and profit increase is particularly dependent on the size of the practice, the offered service portfolio, and the human resource management.

This paper deals with health economic aspects of prevention. After giving a definition of the term prevention, published estimates of the burden of disease attributable to selected risk factors are presented. These estimates suggest that a considerable share of morbidity, mortality and health care costs may be avoided through prevention. Subsequently, the paper describes the methods that can be used to analyze the cost-effectiveness of preventive services. Typical problems arise from the necessity to estimate long-term costs and effects, which often requires modeling. A specific problem refers to whether so-called unrelated future health care costs caused by other diseases in life years gained through prevention should be included when calculating the costs of prevention. Economic evaluations of preventive services published in the literature often report very favorable cost-effectiveness ratios. In order to increase the efficiency of health care, more cost-effective preventive services should be developed and used.

Background: In the second half of the 20th century the medical profession has changed considerably. "The golden age of medicine" seems to be over. This study analyses job satisfaction and prospects of Austrian physicians in the twenty-first century., Methods: A questionnaire was sent to all 289 internal medicine specialists in Upper Austria (the third largest of the nine Austrian provinces, with more than one million inhabitants). The main topics were: career choice, job satisfaction, and strategies for the future. Also aspects such as group practices, the position of general internal medicine physicians as opposed to those with further specialisation (e.g. cardiologists, nephrologists, etc.) were addressed., Results: Austrian internal medicine specialists are generally content with their job, most of them would study medicine and specialize in internal medicine again. They experience more job satisfaction than their German colleagues. However, Austrian internal medicine specialists suffer from the additional workload caused by administration and bureaucracy. There is a general consensus among most internal medicine physicians that nowadays patients expect them to provide more information. Particularly doctors employed at hospitals experience a more aggressive attitude and an increased readiness to sue in their patients. Although 75% look positively towards the future, two thirds expect a cutback in their economic situation. The majority of Austrian internal medicine specialists consider group practices to be the way of the future., Conclusion: The vast majority of Austrian internal medicine specialists are satisfied with their job. Although the majority expects economic cutbacks in the future, most would study medicine and specialize in internal medicine again. Group practices are considered to be the way of the future.

We analyzed the diagnostical and therapeutical costs of 300 ambulatory patients over a two year period in a Swiss university policlinic of internal medicine. The calculations were based on the catalogue of hospital services (Spitalleistungskatalog) and the drugstore prices for pharmaceuticals (Apothekenpreise). The overall costs for the 300 patients were about 238,400 CHF. The refund by the health insurances represented 56% (excluding specific services such as radiological examinations). The main costs concerned analytical laboratory services (32%), physicians services (27%), technical services (26%), and pharmaceuticals (15%). Some analytical and technical services were prescribed unexpectedly frequently. Prevalent among the emitted pharmaceuticals were protone pump inhibitors, modern cardiovascular drugs and statins. Presumed reasons may be a minor cost awareness of the physicians and a trend towards modern but expensive therapies. An adequate cost awareness can only emerge from precise data of effective costs.

The medical diagnoses and their economic level of severity as well as the treatment costs and the proceeds of an integrated internal - psychosomatic ward C were compared with two conventional internal wards A and B of a general medical department within a hospital of tertiary care level. With a similar economic level of severity of the diagnoses, lethality and costs for nursing care given the medical treatment costs of C were significant lower and the proceeds (minus medical treatment costs and nurses' salaries) calculated according to G-DRG version 1.0 higher than those of A and B. Integrated internal medicine is more cost effective compared to conventional internal medicine.

Study Objective: As from 2004, a diagnosis-related group financing system will be introduced in all somatic departments and wards in Germany. In future, only psychiatric and psychosomatic departments will continue the system of patient-related per capita budgeting. In view of this fact, it is necessary to determine which hospital wards or departments admit mentally ill patients, as the funding--and hence the therapeutic options available--will vary fundamentally between psychiatric and somatic departments., Method: An evaluation was made of more than 1,000,000 hospitalised patients on the books of the country's second largest medical insurance organization, the DAK, in the year 2001. Of these cases, almost 68,000 were in the diagnostic category F (psychiatric diagnoses) ICD-10., Findings: Some 32.4 % of cases where the main diagnosis upon dismissal was psychiatric were admitted to somatic wards, most of them (19.3 % of the total) to internal medicine wards. A comparison between the different Federal States of Germany showed that the practice of admitting a substantial proportion of psychiatric diagnoses to somatic wards was not a merely regional problem, but widespread throughout the country. A disproportionately large number of those in somatic wards, mainly internal medicine wards, were in the diagnostic categories F13 (medication dependency), F10 (alcohol-related), F0-09 (cerebral organic disorders) and F40-48 (neurotic disorders). As a rule, the duration of hospital stay on somatic wards was less than half as long as on psychiatric wards. Two thirds of the internal medicine departments that dismissed patients with psychiatric diagnoses were in general hospitals that did not have their own psychiatric department. On the internal medicine wards the second most common diagnostic group in the age group 16-64 years, after ischaemic heart disease (I25), was alcohol-related disorders (F10)., Conclusions: On the basis of these findings one could expect to find "mixed funding" of specific types of psychiatric diagnosis upon the introduction of the German budgeting practice system, although as a rule this will probably apply mainly to internal medicine departments with psychiatric budgets. As this system encourages shorter periods of hospitalization it seems likely that some of these patients will be transferred to psychiatric/psychosomatic wards after just a few days. However, it appears unlikely that there will be a corresponding increase in the number of psychiatric beds. For this reason, it is important that provision be made to accommodate psychiatric cases elsewhere, preferably in somatic, mainly internal medicine, wards. This expansion of capacity should also include the extension of activities carried out by the psychiatric/psychosomatic counselling and liaison services, as well as the introduction of short crisis intervention techniques and the so-called qualified detoxification of alcohol-abuse patients on internal medicine wards. As the present system offers no incentive to general hospitals to take such measures we can expect demand for beds in psychiatric/psychosomatic hospitals to increase. Furthermore, it is probable that there will also be an increase in the number of re-admissions of such patients, especially alcoholics, to somatic wards.

Objective: Outstanding medical research is not possible without financial support. The success of supported research projects have been evaluated only rarely. The publication rate of research projects supported by the German Research Council (Deutsche Forschungsgemeinschaft [DFG]) was assessed separately for internal medicine, surgery, and anesthesiology., Methods: Based on the "Figures and Facts" published by the DFG all supported projects of 1996 for all three specialities were included. In a Medline-based analysis all published papers dealing with the supported project and all papers published by the supported persons from 1996 to may 2000 were documented., Results: A total of 315 grants were analysed (internal medicine: 234; surgery: 63; anesthesiology: 18). Projects with clinical topics were less often supported (n = 80) than experimental projects (n = 235). 162 (69.3%) of the grants in internal medicine, 41 (65.1) in surgery, and 14 (77.8%) of the grants in anesthesiology were published. In anesthesiology all published projects were in English language (internal medicine: 98.2%; surgery: 95%). Independent of the topic of the grant, several supported persons in internal medicine and surgery did not publish any papers between 1996 and may 2000, whereas all supported anesthesiologists published papers in peer reviewed journals in this time period., Conclusion: The publication rate of DFG supported projects is not sufficient. Except for a final internal report after finishing the research project no quality control exists for DFG grants. Unfortunately, not all supported projects were published. A better feedback between the financial support by the DFG and the publication rate of DFG grants is desirable.

Data of an investigation on initial motives for and outcome of so-called diagnostic check-ups are presented. Over a period of about one year a total of 82 persons applying for such a check-up have been investigated. Concrete reasons for this step were not given initially, however, elucidated in 87% of cases after special interrogation. Mostly fear of carcinoma or HIV-infection because of unspecific symptoms or diseases of family members or friends was reported. Clinical status and additionally arranged investigations (laboratory and others) revealed as a rule no further relevant pathological findings, thus, acting mainly to exclude rather than prove a disease. If motives for such check-ups could be elucidated in time, a more focussed, cost-effective investigation could be initiated, with more benefit for the patient and higher satisfaction for the physician. Such a screening consultation might represent furthermore a good opportunity to communicate preventive aspects to the patient.

Background and Objective: Treatment in an intensive care unit (ICU) is very expensive. Aim of this study was to determine the exact composition of costs and to analyse what factors are responsible for the rise in costs over the last 5 years., Methods: In a prospective investigation all 790 patients who had been treated at the ICU of the Medical Department of Frankfurt University during 1992 were included, findings being compared with data on all 208 patients treated in the ICU in May and June 1997. All important diagnostic and therapeutic measures were quantitatively determined each day., Results: The mean age of the ICU patients rose in the 5 years from 55 to 59 years (P < 0.001). Mean period of stay in the ICU remained unchanged (4.1 days), total duration of hospital stay (15 and 12 days, respectively), and treatment intensity (sum of points according to the "Therapeutic Intervention Scoring System" per ICU stay: 96 and 77, respectively). The mortality rate in the ICU fell from 16.3% to 10.6% (P = 0.02), hospital mortality rate from 23% to 14% (P = 0.01). Total cost rose from DM 797,860 to DM 1,148,945 per 100 patients (+44%). Of this total, personnel costs were DM 286,885 in 1992 and 356,091 in 1997 (+24%), costs for apparatus-based diagnostic and therapeutic tests were DM 169,743 and 245,156, respectively (+44%), DM 98,496 and 129,222 for drugs (+31%), and DM 60,399 and 186,671 (+209%) for blood and clotting products (in each category per 100 patients). Per case costs rose from DM 7970 to 11,489, per day costs from DM 1943 to 2831. 90% of cost increases were due to new strategies in the treatment of patients with myocardial infractions and those with severe clotting disorders and a rise in personnel costs., Conclusion: The costs of a stay in the ICU has greatly increased over the last 5 years, the main causes being a change to new forms of treatment, especially in patients with myocardial infarction and those with haemophilia.