gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Health Services Research into the German statutory and private healthcare system

Meeting Abstract

  • Karl J. Krobot - University of North Carolina at Chapel Hill, NC, USA
  • Jay S. Kaufman - University of North Carolina at Chapel Hill, NC, USA
  • Dale B. Christensen - University of North Carolina at Chapel Hill, NC, USA
  • John S. Preisser - University of North Carolina at Chapel Hill, NC, USA
  • William C. Miller - University of North Carolina at Chapel Hill, NC, USA
  • Michel A. Ibrahim - University of North Carolina at Chapel Hill, NC, USA

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds113

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2005/05gmds014.shtml

Veröffentlicht: 8. September 2005

© 2005 Krobot et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction and objectives

In Europe only the Netherlands and Germany provide opportunities for research into two-tiered healthcare systems. We therefore present methods of comparative health services research into the German statutory (SHI) and private (PHI) health insurance system on the basis of patient-level secondary data.

Methods and Results

We used the example of the first selective vascular 5HT1B/1D receptor agonist sumatriptan in a large sample of statutorily (SHI) and fully privately health-insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second (1994) to fourth (1996) year of the Healthcare Structural Reform Act. PHI patients were regarded as “exposed” and SHI patients as “unexposed”. The outcome was prescriptions for oral or subcutaneous sumatriptan as opposed to nonserotoninergic migraine attack therapies. Firstly we determined whether a disparity between the two systems existed. We then developed a novel person-time-related hurdle model and used it to characterize more precisely the disparity that was found. We estimated the epidemiologic consequences as a population-attributable risk fraction. In order to present the findings in a more easily understandable format, we adapted Brenner’s risk advancement period [1]. Generalized estimating equations accounted for clustering of patients within practices. Figures 1-4 [Fig. 1], [Fig. 2], [Fig. 3], [Fig. 4] do present the main results.

Discussion

SHI migraine patients, i.e. more than 90 percent of all patients with migraine headaches in Germany, were found to be considerably disadvantaged in terms of access to health benefits from triptan therapy [2], [3], [4] . Health policy research confined to the SHI system may be inadequate; the public must be provided with comprehensible information on the nationwide quality of healthcare service provision. The methods exemplified here may foster such research.


References

1.
Brenner H, Gefeller O, Greenland S. Risk and rate advancement periods as measures of exposure impact on the occurrence of chronic diseases. Epidemiology 1993; 4(3): 229-36.
2.
Krobot KJ, Miller WC, Kaufman JS, Preisser JS, Christensen DB, Ibrahim MA. The disparity in access to new medication by type of health insurance: Lessons from Germany. Med Care. 2004; 42(5): 487-91.
3.
Krobot KJ, Kaufman JS, Miller WC, Preisser JS, Christensen DB, Ibrahim MA. Accessing a new medication in Germany: A novel approach to assess a health insurance-related barrier. Ann Epidemiol, in print 2005.
4.
Krobot KJ, Miller WC, Kaufman JS, Christensen DB, Preisser JS, Ibrahim MA. Quantifying delay in access to new medical treatment: An application of risk advancement period methodology. Epidemiology 2004; 15(2): 202-207