Gefasschirurgie最新文献

Introduction: The demographic development in Germany, especially in Saxony-Anhalt (SA), also poses challenges for vascular surgery, as the incidence of vascular diseases has increased following demographic change. For example, the prevalence of peripheral arterial occlusive disease (PAOD) in industrialised countries is estimated at around 10-20% in people over 60 years of age; thus, the number of people affected will also increase here with demographic change. Especially in rural areas, it seems to be more difficult for patients to reach appropriate specialist treatment.

Material and methods: A compact narrative brief review, based on selective references from the current medical-scientific literature and our own experiences from daily practice in setting up a vascular surgery department in a rural area.

Results: In 2020, the population in the rural district of Jerichower Land (SA) was approximately 89,403 (male: 44,489; female: 44,914). The age distribution in the age groups relevant for PAOD is as follows: 65-74 years-total, 12.38%; 75 years and older-total, 13.85%; average age, 48.36 years (population density, 56.4/km²). According to the SA Association of Statutory Health Insurance Physicians, there were 605 patients for every doctor in Burg (SA) in 2019.There was a total of 5087 people in need of long-term care in the district in 2019. With such a low population density, low doctor density, high mean age, high proportion of people over 75 years of age and a high number of people in need of care, limited mobility and accessibility to vascular surgery care are to be expected, which was also reflected in the high number of PAOD of stage IV (FONTAINE) in the initial patient clientele.Every establishment of a vascular surgery department is associated with a considerable financial and material investment, which the provider of the facility must be prepared to make.In addition to the material investment, the availability of appropriately qualified staff to implement and maintain continuity of care must also be seriously considered.

Conclusion: The high proportion of residents at risk of and suffering from PAOD in a rural area with low population and doctor density allows investment in the establishment of a new vascular surgery department to ensure local care in this patient group with limited mobility and self-help, thus, ultimately from an appropriate health policy perspective but also from the perspective of a relevant revenue outlook.

Background: Over the past 30 years the number of hospitals in Germany has fallen by 21% and the number of hospital beds by 27%. During the same period the average length of stay in hospitals has halved. Nevertheless, the system efficiency is too low.

Objective: The causes of the system inefficiency in the German hospital sector and approaches for a hospital reform are presented.

Material and methods: The official statistics were analyzed and a summary of fundamental works, studies and expert recommendations is given in a review article.

Results: The regulatory coexistence of hospital planning and hospital financing leads to a structural underfunding of hospitals and to a suboptimal supply with hospital services. The purely inpatient-oriented remuneration system conserves inpatient forms of treatment. In an international comparison there is a high hospital density in Germany. This intensifies the shortage of specialist personnel in healthcare professions. In addition, the level of digitalization in German hospitals is too low.

Conclusion: A reduction of the number of hospitals in conjunction with increased specialization can increase the quality of hospital treatment for the patients and also increase the effectiveness of the deployment of scarce specialist personnel. There is a need for a differentiated financing concept according to treatment levels. An increase in the attractiveness of specialist healthcare professions, particularly by improvement of the training can counteract the shortage of specialist personnel. The hospital system must catch up with digitalization in order to be able to provide up to date equipped workplaces and modern organized work processes and also to improve the economic efficiency.