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Ideas and societal structure interact. This paper focuses on relationships between the history of ideas and mental health reform in Italy, Great Britain and Germany. The Italian reform process is based on the ideas of Jean-Paul Sartre, Michel Foucault, phenomenology and Antonio Gramsci, with issues of human rights and social inclusion taking central stage; diagnostic concepts are (temporarily) put in brackets. In Great Britain, there is a strong tradition of empiricism coupled with Erving Goffman's institutional critique and analysis, evangelical (and Quaker) traditions of 'pauper and lunacy' politics, and high-quality evaluation of services. In (the Federal Republic of) Germany, Foucault, Goffman, anthropological-phenomenological psychiatry and international impulses are relevant. With its radical institutional critique and transformation towards comprehensive community care (in the face of tight finances), Italy's mental health reforms are impressive. In Great Britain there is a long-term orientation towards community mental health care, evidence-based services and a focus on patient rights (mixed with neoliberal elements in recent decades). In Germany, mental hospital reform was carried out based on the recommendations of a national Psychiatric Enquiry (White Paper, Psychiatrie-Enquête, 1975) but large psychiatric institutions are not closed, community psychiatric transformation is delayed. There is a recent surge of integrated care models with flexibility of care provision across the inpatient-community divide.

Changes at German universities, such as an increasing workload and a shift towards competition, require investments in health promotion. University Health Management (UHM) aims to support the development of a health-promoting setting. While conceptual considerations emphasize promising success factors for UHM, empirical studies are lacking. The aim of this qualitative study is therefore to identify facilitators and barriers to the implementation of UHM from the perspective of experts.We interviewed 26 experts in guideline-based interviews regarding facilitators and barriers to implementing UHM. Data were analysed using content-analytical methods following Kuckartz, assisted by MAXQDA 2020 software.We identified eight factors that can be both supportive and inhibiting in the implementation of UHM: university leadership, health as a topic within universities, networks, collaboration and exchange, structural organization, target groups, financial resources, collaboration with health insurance providers, and state university laws. Additionally, individual supporting factors, such as adherence to guidelines for a healthy university, or barriers, such as a heterogeneous understanding of UHM and time constraints, influence the implementation.Various facilitators and barriers can be found when introducing UHM. These factors need to be considered within the diverse structures, historical backgrounds, and sizes of universities. Thus, there is no universal blueprint for the development and implementation of UHM. A uniform understanding of UHM and the integration of health into state-level university seem fundamental for the successful implementation of UHM.

The VersKiK-study is based on a record-linkage between the German Childhood Cancer Registry (GCCR) and claims data from statutory health insurances (SHI) in order to investigate the frequency of late effects and long-term medical care among pediatric cancer survivors.GCCR defined a basic population of approximately 50,000 former patients with cancer in childhood or adolescence (years of diagnosis 1991-2021) who survived until 1.1.2017. Encrypted GCCR identity data were stochastically linked with encrypted identity data from 13 SHI. For those cancer patients who could be identified in SHI records (study population), claims data covering 2017-2021 were added and combined with basic GCCR information on cancer diagnosis. A comparison between identified cancer patients and those who were not identified in SHI records was made to evaluate the representativeness of the study population for quantitative analyses.A total of 26,127 former childhood cancer patients were identified in SHI data. Since the participating SHI represent approximately two-thirds of the German population, the record linkage could be judged as satisfactory (84% matching rate). We found no significant differences between the study population and the non-matched group regarding age, sex, primary cancer diagnosis, and year of diagnosis.The identified study population is considered representative for survivors of childhood cancer in Germany.

  Since December 2018, statutory health insured people with indication for tonsillectomy/tonsillotomy have the right to obtain a second opinion (SO) according to the SO directive. It is a legal requirement that the physician providing the indication has to inform the patient about his/her right to obtain an SO. This has to be done usually at least 10 days before the procedure, but in any case in time for the patient to make a well-considered decision about seeking an SO. The aim was to assess waiting times for appointments with physicians to obtain an SO.  In our study of simulated patients, all practices with physicians of the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe providing SO (n=53 medical practices) were contacted via phone up to three times between January and February 2022. Using a standardized and piloted protocol, it was stated that there was an indication for a tonsillectomy/tonsillotomy and that the patient wanted to make an appointment for an SO. It was assessed how long the waiting time for an appointment would be, as well as whether it would be possible to obtain the appointment via video consultation and whether any further questions or details were provided during this telephone call (e. g. reference to documents to be brought along).  Overall, 94.4% (50/53) of the medical practices could be reached. A great majority of them (92% (46/50)) offered an appointment in contrast to three medical practices that offered open consultation hours. The remaining practice offered both ways to obtain an SO. On average, a waiting time of 8.1 (Standard deviation 5.4) working days was needed for an appointment in the morning and 10.1 (standard deviation 5.9) for an appointment in the afternoon. The availability of the medical practices was high. In 31% of cases, it took longer than 10 days to obtain the SO. Nevertheless, the overall waiting times were short.  In principle, patients should be provided with a timely appointment for an SO, which is possible within the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe. The SO is very rarely offered via video consultation. However, this could possibly increase rural care.

How did psychiatry develop as a field of municipal politics in Germany? Decisive prerequisites for this can be found in the reform psychiatry of the early 20th century, but above all in the socio-medical reform movement of the Weimar period, when municipal health authorities set up counselling and support services for mentally ill people. These were instrumentalised by National Socialism for its racist extermination programme, and it was not until the psychiatric reform that began in the 1970s that these approaches were taken up again. The far-reaching responsibilities of the municipal authorities, which had already been established in the Weimar period, supported the resurgence of an active organisation of the local psychiatric care system by the municipal health authorities. With its own social psychiatric services, the task of coordinating psychiatry and structures such as psychosocial working groups, health conferences and community psychiatric associations, psychiatry has become a field of active municipal policy with the goal of an inclusive society.

Around a quarter of the German population has a migrant background. There are some differences in the healthcare provided to migrants and their successor generations compared to people without a migrant background. The aim of this review was to show the different definitions of intercultural competence (ICC), the different target groups of doctors and nursing staff given ICC training courses, and the extent to which the effectiveness of these courses can be assessed with the help of existing quality criteria.Relevant publications were found by searching PUBMED, reviewing the references and literature databases of the participating authors and additionally using Google and Researchgate web searches. Both German- and English-language publications were included in the search.There are several definitions and explanations of ICC, some of which differ, but most of of them include the aspects of cultural awareness, cultural knowledge, cultural sensitivity, cultural interaction and cultural understanding. Previous studies show different target groups for ICC training and a methodologically heterogeneous assessment of the effectiveness of these measures.There is a great need for methodologically sound studies using standardised and objectifiable criteria for the evaluation of intercultural training. Further development of measures, guidelines and political framework conditions would be important for patients, professionals, organisations and associations.

The health economic impacts of centralization in the German healthcare system, particularly in the field of ENT, are insufficiently researched. Therefore, this study investigates the potential benefits of a head and neck tumor center using the example of surgical care for laryngeal carcinoma in Schleswig-Holstein.A systematic literature review was conducted using the PRISMA search schema to examine the correlation between a hospital's treatment volume and mortality rates for laryngeal carcinomas. Subsequently, an 8-year Markov model simulation was employed to demonstrate the effects of establishing centers. This was supplemented by a cost analysis based on data from the PROGNOS study.The simulation shows the hypothetical impact on patient care for the existing head and neck tumor center in Schleswig-Holstein over an 8-year period. Maintaining the center in Schleswig-Holstein over eight years would save 113 lives and gain 1,333 life years (equivalent to 933.1 QALYs), corresponding to costs of 12,866 euros per QALY.The results suggest that centralizing care has medical and economic effectiveness in the ENT sector. They provide important insights for current political discussions and decision-making processes in healthcare. Future research should expand the focus to include other ENT cancers to gain a more comprehensive understanding of the impacts of centralization.