The SGB IX is the legal basis of rehabilitation in Germany since 2001. It is embedded in the codification of the German social code, the Sozialgesetzbuch (SGB). There it has an intermediate function between the general social law and the special laws of the social insurance and social security institutions. Rehabilitation in Germany is working in a system of several different institutions with different legal roots. In special these are compensation of damages caused by employment accident and war and the avoidance of disability benefits by rehabilitation and activation. Inequality of treatment of disabled people according to the cause of their disability and to their employment status are accepted less; common principles of rehabilitation are being searched. Important reforms of rehabilitation law have taken place in 1974 and 1975. Since then problems have become visible in implementation and in the coordination of the complex system. SGB IX is a new effort for a general rehabilitation law. Open questions remain in handling the relations between rehabilitation and sickness treatment, long term care and prevention. Important are the newly defined terms for participation (Teilhabe) and disability (Behinderung), which build the linkage of SGB IX with constitutional law and with the health sciences. A weak point is still the relation of disability and age. Political attempts for unequal benefits in health insurance endanger the now reached level of rehabilitation law.
{"title":"Das SGB IX in der Entwicklung des Sozialrechts1","authors":"F. Welti","doi":"10.1055/s-2002-33268","DOIUrl":"https://doi.org/10.1055/s-2002-33268","url":null,"abstract":"The SGB IX is the legal basis of rehabilitation in Germany since 2001. It is embedded in the codification of the German social code, the Sozialgesetzbuch (SGB). There it has an intermediate function between the general social law and the special laws of the social insurance and social security institutions. Rehabilitation in Germany is working in a system of several different institutions with different legal roots. In special these are compensation of damages caused by employment accident and war and the avoidance of disability benefits by rehabilitation and activation. Inequality of treatment of disabled people according to the cause of their disability and to their employment status are accepted less; common principles of rehabilitation are being searched. Important reforms of rehabilitation law have taken place in 1974 and 1975. Since then problems have become visible in implementation and in the coordination of the complex system. SGB IX is a new effort for a general rehabilitation law. Open questions remain in handling the relations between rehabilitation and sickness treatment, long term care and prevention. Important are the newly defined terms for participation (Teilhabe) and disability (Behinderung), which build the linkage of SGB IX with constitutional law and with the health sciences. A weak point is still the relation of disability and age. Political attempts for unequal benefits in health insurance endanger the now reached level of rehabilitation law.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116773247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the mid-90s outpatient rehabilitation has been developed by public health insurance companies and pension funds. Outpatient rehabilitation is defined as comprehensive multidisciplinary and medically supervised service which in neurological rehabilitation mostly follows inpatient rehabilitation. In the present paper partial results of a larger study (by Schoenle and Leyhe, 2000) are reported with respect to the follow-up of the effects of outpatient versus inpatient rehabilitation 6 month after termination of the treatment. Major results are the endurance of the effects over the observed time interval and the equivalent effectiveness of the two forms of rehabilitation. Distinct effects were observed for the two patient groups (more progress in the body related functional disturbances for inpatients versus cognitively related progress for the outpatients). The results reflect intrinsic features of neurological rehabilitation and the current organizational status of neurological rehabilitation in Germany.
{"title":"Ambulante und stationäre neurologische Rehabilitation - ein katamnestischer Vergleich","authors":"P. Schönle","doi":"10.1055/s-2002-28442","DOIUrl":"https://doi.org/10.1055/s-2002-28442","url":null,"abstract":"Since the mid-90s outpatient rehabilitation has been developed by public health insurance companies and pension funds. Outpatient rehabilitation is defined as comprehensive multidisciplinary and medically supervised service which in neurological rehabilitation mostly follows inpatient rehabilitation. In the present paper partial results of a larger study (by Schoenle and Leyhe, 2000) are reported with respect to the follow-up of the effects of outpatient versus inpatient rehabilitation 6 month after termination of the treatment. Major results are the endurance of the effects over the observed time interval and the equivalent effectiveness of the two forms of rehabilitation. Distinct effects were observed for the two patient groups (more progress in the body related functional disturbances for inpatients versus cognitively related progress for the outpatients). The results reflect intrinsic features of neurological rehabilitation and the current organizational status of neurological rehabilitation in Germany.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116356937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.
{"title":"Ambulante und stationäre orthopädische Rehabilitation - Ergebnisse einer Studie zum Vergleich der Behandlungsergebnisse und Kosten","authors":"W. Bürger, S. Dietsche, M. Morfeld, U. Koch","doi":"10.1055/s-2002-28437","DOIUrl":"https://doi.org/10.1055/s-2002-28437","url":null,"abstract":"This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131468711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regarding the ongoing dispute on strengthening outpatient medical rehabilitation programmes, questions arise about the quality of different (organizational) forms of rehabilitation (inpatient and outpatient). The aim of this contribution is to draw a comparison between the structures and processes of inpatient and outpatient facilities for cardiac rehabilitation. Additional questions will be posed regarding the prerequisite factors for improving structures and processes in the quality assurance and management framework.
{"title":"Die Qualität der Organisation kardiologischer Rehabilitation - Ein Vergleich stationärer und ambulanter Versorgungsformen","authors":"O. Iseringhausen, T. Schott, A. V. Orde","doi":"10.1055/s-2002-28447","DOIUrl":"https://doi.org/10.1055/s-2002-28447","url":null,"abstract":"Regarding the ongoing dispute on strengthening outpatient medical rehabilitation programmes, questions arise about the quality of different (organizational) forms of rehabilitation (inpatient and outpatient). The aim of this contribution is to draw a comparison between the structures and processes of inpatient and outpatient facilities for cardiac rehabilitation. Additional questions will be posed regarding the prerequisite factors for improving structures and processes in the quality assurance and management framework.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123593788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
grundsätzlich anzuwendende Methodik bei der ökonomischen Beurteilung Vollerhebung randomisierte kontrollierte total population randomized controlled
本守则以全面随机控制的、受控的动物数量评估标准为标准
{"title":"Wirtschaftliche Aspekte der ambulanten Rehabilitation - Methodische Ansätze und Zwischenergebnisse aus einem Projekt zur Wirtschaftlichkeit ambulanter Rehabilitation in Mecklenburg-Vorpommern","authors":"H. Klingelhöfer, A. Lätzsch","doi":"10.1055/s-2002-28445","DOIUrl":"https://doi.org/10.1055/s-2002-28445","url":null,"abstract":"grundsätzlich anzuwendende Methodik bei der ökonomischen Beurteilung Vollerhebung randomisierte kontrollierte total population randomized controlled","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131633717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac rehabilitation plays a pivotal role in the care for cardiac patients. Yet without sufficient continuity in the care process, the good results achieved in the different stages of therapy and recovery may not last. The aim of this contribution is to highlight the interfaces of cardiac rehabilitation in regard of process continuity as an aspect of the quality of health care. The results show that continuity between the acute care unit and inpatient rehabilitation programmes (phase I - phase II) seems to be sufficient whereas integrating phases II and III may be open for optimizing.
{"title":"Kontinuität und Prozessqualität in der Behandlung der chronischen Herzerkrankung: Der Zugang zur Rehabilitation und die Schnittstelle zum Alltag","authors":"T. Schott, O. Iseringhausen, A. V. Orde","doi":"10.1055/s-2002-28443","DOIUrl":"https://doi.org/10.1055/s-2002-28443","url":null,"abstract":"Cardiac rehabilitation plays a pivotal role in the care for cardiac patients. Yet without sufficient continuity in the care process, the good results achieved in the different stages of therapy and recovery may not last. The aim of this contribution is to highlight the interfaces of cardiac rehabilitation in regard of process continuity as an aspect of the quality of health care. The results show that continuity between the acute care unit and inpatient rehabilitation programmes (phase I - phase II) seems to be sufficient whereas integrating phases II and III may be open for optimizing.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116313188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regarding the dominance of inpatient medical rehabilitation programmes efforts have emerged over the last few years to strengthen outpatient medical rehabilitation programmes in Germany. The goal of cardiac rehabilitation is the recovery of physical, psychic and social wellbeing in people with a severe heart condition. For this contribution the central outcomes of cardiac rehabilitation were compared between different rehabilitation programmes (inpatient and outpatient) and cost-effectiveness analyses were made. These results were obtained within the scope of an evaluation study commissioned by the statutory health and pension insurance agency. In summary, the different rehabilitation programmes can be regarded as comparable concerning effectiveness and costs following rehabilitation.
{"title":"Behandlungsergebnisse der kardiologischen Rehabilitation und Kosten-Wirksamkeits-Relationen - Ein Vergleich stationärer und ambulanter Versorgungsformen","authors":"A. V. Orde, T. Schott, O. Iseringhausen","doi":"10.1055/s-2002-28446","DOIUrl":"https://doi.org/10.1055/s-2002-28446","url":null,"abstract":"Regarding the dominance of inpatient medical rehabilitation programmes efforts have emerged over the last few years to strengthen outpatient medical rehabilitation programmes in Germany. The goal of cardiac rehabilitation is the recovery of physical, psychic and social wellbeing in people with a severe heart condition. For this contribution the central outcomes of cardiac rehabilitation were compared between different rehabilitation programmes (inpatient and outpatient) and cost-effectiveness analyses were made. These results were obtained within the scope of an evaluation study commissioned by the statutory health and pension insurance agency. In summary, the different rehabilitation programmes can be regarded as comparable concerning effectiveness and costs following rehabilitation.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114201741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Winge, A. Mohs, K. Müller, L. Nörenberg, L. Pannicke, B. Robra
: Interfaces can cause disruptions in the care provision process. They can, however, also signify a differentiated and specialized division of labour of the care providing system. Three models for the description of interfaces are presented and compared: a linear model oriented towards the continuity of the provision of care for individuals, the Principal Agent (PA) Model from contract theory, and a complex systems model. In all three models coupling and information management are identified as essential interface functions. In regard to optimisation possibilities, the linear model leads to the case-management concept, the PA Model to integrated forms of provision and systems theory to context controlling.
{"title":"Schnittstellen in der Rehabilitation - Drei Modelle","authors":"S. Winge, A. Mohs, K. Müller, L. Nörenberg, L. Pannicke, B. Robra","doi":"10.1055/s-2002-19955","DOIUrl":"https://doi.org/10.1055/s-2002-19955","url":null,"abstract":": Interfaces can cause disruptions in the care provision process. They can, however, also signify a differentiated and specialized division of labour of the care providing system. Three models for the description of interfaces are presented and compared: a linear model oriented towards the continuity of the provision of care for individuals, the Principal Agent (PA) Model from contract theory, and a complex systems model. In all three models coupling and information management are identified as essential interface functions. In regard to optimisation possibilities, the linear model leads to the case-management concept, the PA Model to integrated forms of provision and systems theory to context controlling.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114609450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The forthcoming introduction of the DRG-system as a new hospital funding system in Germany reinforced the discussion about a reform of the already existing funding system in medical rehabilitation. Experience and concepts from acute medicine, however, cannot be transferred directly to rehabilitation. The development of a patient classification system is a presupposition for prospective payment systems. Initial attempts in rehabilitation-specific patient classification systems already exist, even though a comprehensive approach is not yet noticeable. International patient classification systems scarcely seem to be transferable due to the specific German case-mix. The specific differences between acute medicine and medical rehabilitation relevant for the valuation of funding systems are analyzed. Particularly a reduction of the length of stay as a primary aim for the introduction of the DRG-system does not seem appropriate for medical rehabilitation. The existing funding system in medical rehabilitation is analyzed from an economic point of view. The cost management of the German pension insurance, being one of the rehabilitation providers in Germany, has achieved high quality standard of treatment as well as cost restriction. This funding system has been further developed during the last couple of years. Future developments are shown.
{"title":"Gesundheitsökonomische Analyse der Vergütung mit Fallpauschalen in der medizinischen Rehabilitation","authors":"H. Haaf","doi":"10.1055/s-2002-19956","DOIUrl":"https://doi.org/10.1055/s-2002-19956","url":null,"abstract":": The forthcoming introduction of the DRG-system as a new hospital funding system in Germany reinforced the discussion about a reform of the already existing funding system in medical rehabilitation. Experience and concepts from acute medicine, however, cannot be transferred directly to rehabilitation. The development of a patient classification system is a presupposition for prospective payment systems. Initial attempts in rehabilitation-specific patient classification systems already exist, even though a comprehensive approach is not yet noticeable. International patient classification systems scarcely seem to be transferable due to the specific German case-mix. The specific differences between acute medicine and medical rehabilitation relevant for the valuation of funding systems are analyzed. Particularly a reduction of the length of stay as a primary aim for the introduction of the DRG-system does not seem appropriate for medical rehabilitation. The existing funding system in medical rehabilitation is analyzed from an economic point of view. The cost management of the German pension insurance, being one of the rehabilitation providers in Germany, has achieved high quality standard of treatment as well as cost restriction. This funding system has been further developed during the last couple of years. Future developments are shown.","PeriodicalId":423642,"journal":{"name":"Rehabilitation Die","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122543964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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