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Fast zwanzig Prozent aller Mütter, Väter und pflegenden Angehörigen benötigten bereits vor der Pandemie eine Rehabilitations- oder Vorsorgemaßnahme. Zahlreiche Studien zeigen, dass sich dieser Bedarf mit großer Wahrscheinlichkeit durch die Pandemie erheblich erhöhen wird. In Befragungen bewerten Ärzt:innen wie ehemalige Patient:innen die Wirkung der von der GKV angebotenen spezifischen Mutter-Vater-Kind-Maßnahmen zumindest kurz- bis mittelfristig positiv, weisen aber auch auf ihre nicht ausreichende Nachhaltigkeit und zahlreiche Defizite im Bereich der Nachsorge hin. Um dem zukünftigen Bedarf gerecht werden zu können, sind Reformen beim Leistungsangebot, der Organisation und Finanzierung von Nachsorge notwendig.

Zusammenfassung Die Bevölkerungsgruppe mit mangelhafter Gesundheitskompetenz ist wegen der rund 15% Analphabeten wahrscheinlich noch erheblich größer als berichtet. Wegen der Mängel der medialen Gesundheitsinformationen und bei der Hilfe von Ärzten ihren Patienten evidente Informationen zu beschaffen, ist das Ziel von besserer Gesundheitskompetenz allein durch mehr Medienkompetenz oder Arztgespräche nicht zu erreichen. Dies ist nur durch gleichzeitige Eingriffe auf der Angebotsseite zu schaffen.

Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.

Development and evaluation of a patient decision aid for young people and parents considering fixed orthodontic appliances by Marshmann et al. (2016). J Orthod. 43:276-287. The development of the first fixed appliance decision aid (FADA) may be an enormous advancement in improving the quality of orthodontic care (Marshmann et al. 2016). The importance of the work arises especially from the fact that decision aids may facilitate the shared decision-making process by means of providing up-todate scientific evidence on benefits and harms if presented in an appropriate format and at a right time point during the patient-physician communication. That is to say, through better information and better understanding, FADA may strengthen patient autonomy which is the fundament of bioethics and professional ethics. As we read through the study however, we have certain doubts that authors conclusion that the FADA provides patient-relevant information, a hallmark of decision aids, probably cannot be drawn from this study. According to the criteria of the International Patients Decision Aids Standards (IPDAS), relevant treatment options presented in the decision aids have to include also the ‘comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence’ (IPDAS 2012). However, according to the section Methods of the study, the authors did not conduct any systematic review and critical appraisal of the available evidence to inform the content of FADA. For example the FADA’s content on root resorption, white spot lesions and patient experience were supported by only few selected single studies without clear selection criteria (Marshmann et al. 2016). Yet if the FADA fails to include some up-to-date and critically appraised evidence it may misinform patients (ethical dimension), cause unnecessary treatments (quality of care dimension) and thus resulting in more harm than good (Montori et al. 2013). We are aware of the difficulties associated with providing up-to-date scientific evidence for available treatment options, often limited funding, time consuming appraisal of literature, or low quality of available systematic reviews, just to mention a few. However, those limitations should be explicitly mentioned in the study so readers may be aware of them when drawing conclusion from the results. Also, strategies have been suggested to overcome the limitations of traditional decision aids and they could be useful in developing the FADA (Agoritsas et al. 2015). To conclude, the authors made a first and probably most important step toward strengthening patient autonomy, given that the content and the presentation of the FADA is truly evidence-based. In orthodontic care, where probably misinformation and subsequent excessive overtreatment are common (Ackermann 2010; Spassov et al. 2015), decision aids may be one valuable strategy to overcome those problems that may causes unnecessary harm and costs to patients and society.

This article describes public trust in health care in three European countries. Public trust is a generalised attitude, influenced by people’s experiences in contacts with representatives of institutions, in its turn influencing how people enter these contacts. In general, people in Germany have less trust in health care, while people in England and Wales have the highest trust levels. Cultural differences between the three countries could be an important source of differences. That makes public trust a less straightforward candidate for use as indicator of the future oriented dimension of user views in an international, comparative performance framework.

Sickness funds became the focal point of health insurance reforms in the 1990s. Policy makers expected funds to become more consumer-oriented and more active in managing the provision of health care. This is especially true for two countries in the heart of Europe that, on first view, have many similar institutional characteristics. Both Germany and The Netherlands have introduced competition between sickness funds in the last decade. We present extensive quantitative, as well qualitative, data with regard to the behaviour of consumers after the introduction of free choice between sickness funds. National data was used with regard to contribution rates and member flows and survey data was used to investigate personal motives for actual change and perception of differences between sickness funds. In Germany, contribution rates between sickness funds differ significantly. Accordingly, these differences are the main reason for consumers to switch funds, which occurs on a considerable scale. However, survey data show that other reasons may be important too. In The Netherlands, premium differences are much lower. The same is true for the degree of change. Survey data show that consumers perceive very small differences between sickness funds and do not see much reason for change. Our findings support the claim that the degree of actual changing depends strongly on economic incentives, especially with regard to the extent of financial risk sickness funds have to bear and to the extent premiums or contribution rates can differ. However, the higher the financial risk of individual sickness funds actually is, the higher the incentives for risk selection.