Germany map of medical care

New Internet portal offers overview of medical interventions

28/09/2011

The portal, available online today „Fact Check "Health" shows marked regional differences in health care The Bertelsmann Stiftung's Initiative for Good Health Care (INIgG) has documented a large number of different interventions and compiled them in a Germany atlas on health care.

The map material on the online portal today shows that health care in Germany depends significantly on the place of residence. On behalf of the Bertelsmann Foundation, the renowned IGES Institute in Berlin had certain medical treatments such as caesarian sections, removal of the palatine tonsils or removal of the cecum in children and adolescents, removal of the uterus, prostate, gallbladder or heart bypass surgery in adults detected. The compilation of the results on the new online health care portal illustrates the enormous regional differences in health care in Germany.

Some differences are quite desirable, as they do justice to the regional characteristics, such as the different average age of the population or the occurrence of certain diseases, explain the experts of the IGES Institute in the accompanying report. However, other deviations can not be explained medically or on the patient side, so that the researchers stimulate a closer examination of the causes. Although the scientists are extremely cautious in their explanations, individual statements suggest that economic reasons could also play a role in regionally different interventions. According to the experts, there are regional imbalances in care, which can not be explained with medical arguments and the age and social structure - there is a certain arbitrariness.

Regional differences in cesarean delivery
For example, the number of cesarean deliveries in the western Eifel is particularly high, but very low in the Chemnitz region. Cesarean deliveries are usually a clear indication of potential harm to the mother and / or child in a natural birth (spontaneous delivery). However, the indexed by age groups of the mothers and 1,000 live births different numbers, according to the experts do not suggest a different threat to mothers and babies in the West Eifel and in Saxony. Rather, this is a different attitude to the cesarean delivery in the two regions expressed. Because in individual cases, a caesarean section is a tradeoff decision, if not „absolute indications“ such as the premature detachment of the placenta or irregular heart sounds of the child speak for such an intervention, the experts explained. For example, the more soft-weighing factors include multiple pregnancies. But also the staffing in the clinics can lead to a planned delivery by caesarean section of the spontaneous delivery is preferred, so the statement in the report of the IGES Institute. Partially, too „Wish birth brought about, for example, if the child is to come on the birthday of the grandma to the world“, the experts continue. In addition, the fear of pregnant women before the natural birth may also be reason for an increased number of Caesarean deliveries. According to the new online portal, liability issues also play a more important role in the decision to undergo caesarean section, since the more controllable cut births are more likely to be used in smaller wards with fewer births per year and lower staffing levels than in the major medical centers and clinics. All these factors lead to two and a half times more cesarean sections in the region with most cesarean sections than in the region with the fewest caesarean sections.

No rational justification for regional supply differences
According to the Good Health Care Initiative figures, these rationally incomprehensible regional differences in care are also reflected in other medical interventions. For example, according to the new online portal, the removal of tonsils (tonsillectomy) in children and adolescents shows marked regional differences , Here the factor lies between the region with the most and the region with the fewest interferences even at 8.3, report the experts of the IGES institute. Accordingly, in the district of Steinburg on the Elbe, the region of Erfurt and Tübingen as well as south of Munich and in Middle Franconia least almond distances are performed, in the district of Schweinfurt by far the most. Here the experts explicitly point out that possibly economic interests could play a role in the different number of interventions. For example, small ENT departments may recommend tonsillectomy more frequently, since a sharp decline in intervention would jeopardize the department's economics, experts suggest. In fact, the palatine tonsils are only removed in children if recurrent purulent tonsillitis is present or the airways are narrowed. Although it is a relatively frequent procedure, the operation is also associated with health risks, such as the risk of uncontrolled bleeding. However, the trade-off between benefits and risks appears to be significantly different in the different regions.

Map captures 16 common treatment areas
The Bertelsmann Stiftung identifies these differences in the new portal so that patients can independently find out about the regional differences. To date, the Foundation has provided data on 16 common treatment areas such as cesarean delivery, removal of the palatine tonsils or cecum in children and adolescents, psychiatric care for adolescents, and removal of the uterus, prostate and gall bladder in adults. Heart bypass surgery, implantation of a defibrillator, first implantation of a knee joint, inguinal and umbilical hernia repair, hospital cases due to diabetes or depression can all be accessed on the new portal. In addition, further evaluations are planned, for example, on the use of antibiotic therapies in children, the experts report. With the help of the online portal, patients should be sensitized to the different regional health care and have the opportunity to see for themselves before an intervention, „as is the case for the health care indicators in (their) region in the indicators considered“, emphasized the board member of the Bertelsmann Foundation, Brigitte Mohn. Critical inquiries can not hurt at this point because „These differences may be an indication that patients sometimes receive medical services that they may not need at all“, so poppy on.

According to the board member of the Bertelsmann Foundation, the regional differences have long been known, because as early as 2001 the German Council of Economic Experts for Health Care Development complained that valuable therapeutic resources were unnecessarily consumed due to regionally varying treatment preferences. Regionally differing contract modalities, lack of therapeutic guidelines and the presence or absence of specialized clinics are the main reasons why certain therapies are chosen very frequently or very rarely. According to the expert, the Rheinisch-Westfälisches Institut für Wirtschaftsforschung in Essen estimated the resulting additional healthcare costs at ten billion euros per year. With the new internet portal „www.faktencheck-gesundheit.de“ This development is now to be counteracted in the long term, according to the statement of reasons of the Bertelsmann Foundation for the establishment of the online offer. (Fp)

Also read:
75 percent prefer alternative medicine
Too many operations in Germany
New doctors portal against unnecessary operations
Health: Number of operations increased sharply
Fact check health

Image: Dieter Schütz