Institut für Health Care & Public Management

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Embracing digital health: German otolaryngology patients’ usage and prospects of digital information and communication technologies for cross-sectoral care
(2024) Holderried, Martin; Hoeper, Ansgar; Stauss, Leonie; Holderried, Friederike; Herrmann-Werner, Anne; Kestler, Hans A.; Ernst, Christian; Baerhold, Friederike; Becker, Sven
Objective: The usage of digital information and communication technologies in European healthcare is growing. Unlike numerous technological possibilities, the present use of these technologies and perspectives towards them in relation to otolaryngology care have so far been of less interest. This study evaluates the utilisation of and attitudes towards digital information and communication technologies in cross-sectoral otolaryngology care among German patients. Methods: A structured interview-based study was conducted at the outpatient facility of a tertiary hospital in Germany. It focused on chief complaints, current use of digital technologies, estimated benefits of increased digital technology use in otolaryngology care, and sociodemographic data. The detailed statistical analysis employed Chi-squared tests and multivariate logistic regression. Results: A total of 208 otolaryngology patients completed the interview. Digital communication technologies exhibited a high penetration rate (91.8%) and were regularly used in daily life (78.7%) and for health reasons (73.3%). Younger age ( p ≤ 0.003) and higher education levels ( p ≤ 0.008) were significantly correlated with the increased digital communication technology use. The overall potential of eHealth technologies was rated significantly higher by younger patients ( p ≤ 0.001). The patients’ chief complaints showed no significant influence on the current and potential use of these technologies for cross-sectoral otolaryngology care. Conclusion: Regardless of their chief complaints, German otolaryngology patients regularly use digital information and communication technologies for health reasons and express interest in their further use for cross-sectoral care. To enhance digital patient communication in otolaryngology, attention should be given to treatment quality, usability, data security and availability and financial remuneration for service providers.
Selektivverträge in der medizinischen Versorgung
(2017) Arnegger, Silke; Ernst, Christian
In the past fifteen years, Germany has introduced several types of medical care and cooperation opportunities between actors in the healthcare market. The gatekeeper model known as Hausarztzentrierte Versorgung (HZV) is a primary physician model and is an example of selective or individual contracting that is now possible between physicians in private practice and health insurance companies. It is also an example of new policy instruments intended to increase competition in the healthcare system (e.g. between insurance companies, amongst physicians in private practice). Increased competition should lead to improvements in the quality of patient care and economic efficiencies in the provision of that care. The latter is an especially important goal in light of the fact that there are a growing number of patients with chronic diseases. Selective medical care contracts like the HZV are situated at this pivot point. Going forward, German health insurance companies and other healthcare market actors – in particular, physicians in private practice – are allowed to enter into individual contracts for the provision of medical care to a group of patients. For this purpose, physicians specializing in a particular field mandate their professional associations to negotiate contracts. Thereafter physicians who want to participate in these contracts can offer the applicable provisions to their patients. Previously, all insurance companies and all registered doctors in private practice were required to enter into collective agreements. Contracts like the HZV mean it should now be possible to study the individual patient care models of different health insurance companies and offer medical care that is better tailored to patients. Additionally, these contracts should encourage communication amongst different actors in the healthcare system and incentivize their behaviour to generate efficiencies. This empirical study aims to explain whether the HZV, namely the selective contracts for primary care physicians in the state of Baden-Württemberg, contain the right incentives for participating doctors (agents) to produce efficient results for the insurance companies with which they have contracted (principals). Data on the quality and efficiency of care provided under these contracts is compared to data on their financial impact on participating doctors. New Institutional Economics inform the theoretical framework used in this study. Its theories of social contract, especially agency, and transaction costs play a central role in interpreting and analysing the data collected. Many studies of selective contracting in the field of healthcare economics focus on legal issues arising from actual and proposed changes to the law. By providing an empirical healthcare oriented economic account of such contracts for primary care physicians in Germany, this study supplements that literature with data and analysis that has been lacking on this important development.

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