Unterschiede in den soziodemografischen Merkmalen,der Gesundheit und Inanspruchnahme bei Kindern und Jugendlichen nach ihrer Krankenkassenzugehörigkeit

Differences in the socioeconomic characteristics and morbidity between members of German private and statutory health insurance funds and also between several statutory health insurances have been shown for adults. We used data from the National Health Survey for Children and Adolescents (KiGGS) to study differences in sociodemographic characteristics, health risks, morbidity, and health service use in child and adolescent insurants of different types of health insurance funds (Ersatzkasse, Allgemeine Ortskrankenkasse, Betriebskrankenkasse , Innungskrankenkasse, other statutory health insurance funds, private health insurance). Differences in the proportion of respondents with a migration background, somatic diseases, psychopathological problems, and contact with a dentist between the different health insurance fund types were found. These results should be considered in studies on health inequalities, which often focus solely on differences between statutory and private health insurance. Our results are also of relevance for health services research using the claims data of health insurance funds.     

A survey of knowledge, attitudes, and behavior of Italian dentists toward immunization

This study assessed the knowledge, attitude, and compliance to immunization guidelines among dental health-care professionals in Italy. A questionnaire was mailed to a random sample of 1000 dentists on demographic and professional characteristics; knowledge regarding infectious diseases that can be acquired/transmitted by the dentist and the vaccinations recommended; attitudes regarding the vaccinations; self-assessed information about previous vaccinations. A total of 369 dentists responded. Only 44.1 and 32.4% correctly indicated all infections that can be acquired or transmitted during their activity. Half of the dentists knew that they should be vaccinated against hepatitis B and influenza and this knowledge was significantly higher in those older, who correctly indicated that hepatitis B and influenza can be acquired and transmitted during their activity, and in those with a positive attitude towards vaccinations. Those younger, involved in specialties with low blood contact, and who did not know that hepatitis B and influenza are vaccinations recommended, were more likely to believe that is important for them to receive vaccinations. A large proportion (85.7%) reported receiving the hepatitis B vaccine, but only 56.2% the three doses. Those with a lower number of years of activity, those who knew that hepatitis B can be acquired by the dentist, those who did not need information, and those who were informed from guidelines, educational courses, and dental associations were more likely to have received the three doses or to be natural immunizated. Training and educational interventions are needed to improve knowledge and immunization coverage.     

Organisationsreform der GKV Anspruch und Wirklichkeit

The new “Health-Structure Bill” (Gesundheits-Strukturgesetz/GSG), which is effective since January 1, 1993, provides some immediate steps, but it also assigns a long-term orientated organizational reform (Organisationsreform) of the German Statutory Health System (Gesetzliche Krankenversicherung/GKV). These measures are aimed to safeguard the financial basis of the GKV and to limit the contribution rates. Hence, the question remains: Is the application of the new methods generating more competition within the GKV or will it lead straight into a state-governed unity insurance fund? This question cannot be answered definitely: On the one hand, the legislator fulfills essential demands for a fundamental reform, e.g. the option of insurance funds, a system of risk compensation between the competing sickness funds (kassenartenübergreifender Risikostrukturausgleich) and modifications of the internal structure of the insurance funds. These reform measures can be valued as necessary requirements of an entry into a competitive statutory health system in Germany after 1996. On the other hand, the legislator has refrained from providing the insurance funds with sufficient competition parameters, has to some extent arranged the risk-compensation system inadequately, and is promoting the concentration process on the level of the sickness funds by means of inappropriate regulations of the market structure. These aspects let suspect that ultimately the GKV could be transformed into a unity insurance fund, de facto. Hence, the GSG leaves open both options. In the last analysis, the design of the German statutory health system to come will depend on the next legislative steps, which will be necessary in the future.     

Prevalence of caries, fissure sealants and filling materials among German children and children of migrants

The aim of this study was to collect information on dental health and dental care of German children and children of migrants for planning oral health promotion in the Rems-Murr-district. To meet this aim all first and fourth degree children in primary and special schools were examined. The dmft- and DMFT-Index, the number of fissure sealants, the filling material used and the children's nationality were recorded. The dmft of 6- and 7-year-olds was 1.50 among Germans, 4.61 among German migrants from Russia, 4.02 among Turks, 4.05 among children from former Yugoslavia, 2.35 among Italians, 1.95 among Greeks and 3.76 among children of other nationalities. At the age of 9 to 10 years Germans had an average of 0.31, German migrants from Russia 0.77, Turks 1.19, children from former Yugoslavia 1.32, Italians 0.64, Greeks 0.69 and children of other nationalities 0.57 DMF-teeth. In both age groups the proportion of caries-free children was highest among Germans and lowest among Turks. Also, more migrants than Germans were referred to a dentist for caries treatment. Compared to the Germans fewer migrants had at least one tooth sealed. The proportion of amalgam fillings to the total number of fillings was higher among 9- and 10-year-olds of Turkish, Italian or Yugoslavian origin than among other nationalities. The results of this study show that further development of oral health promotion programmes for children and parents with Turkish and Russian cultural background has the top-most priority.     

Parents’ receptiveness to oral health clinic-based vaccination

In the United States, utilization of the human papillomavirus (HPV) vaccine has lagged far below public health goals for achieving satisfactory population-level protection against HPV associated cancers. Oral health professionals such as dentists and dental hygienists are important stakeholders in primary prevention of HPV-associated oropharyngeal cancer. We surveyed parents accompanying children to a local pediatric oral health clinic to ascertain their receptiveness to engaging their child’s oral health team in their child’s immunizations. Parents were generally receptive (86%) to discussing vaccines available for their children with both their child’s dentist and dental hygienist. The majority of parents (79%) reported that they would allow their child’s dentist to administer a vaccine to their child. Oral health providers are trusted healthcare professionals poised to make a positive impact on adolescent vaccination programs and they should be included in efforts to improve HPV vaccination rates.     

Free choice of doctors in Germany in retrospect

Due to discussions on the cost and quality of health care and a new legislation on the German statutory sickness insurance system in 1999, the free choice of doctors has recently become topical. To assess its legitimation for the German health care system, its history and the groups of interest involved should be taken into consideration. Before the period of industrialization no homogeneous pattern of the medical profession existed. In case of illness individuals who lived within reach and were known for their competence in disease matters were approached. However, industrialization destroyed existing social networks, and establishment of new structures of health care in rural as well as metropolitan areas became necessary. The government approached this challenge by structuring medical education, passing regulations on the settlement of doctors and promoting the foundation of statutory sickness funds. The Health Insurance Law of 1883 established a mandatory insurance system for a broad array of industries. As it was the sickness funds' responsibility to provide sufficient resources for medical care, a sick member was tied to the physician under contract with his insurance. After a rapid increase in practising physicians at the end of the 19(th) century, doctors' organisations were eager to gain access to the new market segment of insurance members by calling for the free choice of physicians. The Leipzig association (Hartmannbund) was founded in 1900 to organize strikes of doctors in order to get their goals accepted. After 30 years of conflicts an appeasement was achieved by a presidential emergency law in 1931. It transferred the responsibility for the provision of sufficient health care resources from the sickness funds to the newly created body of the Association of Sickness Fund Physicians (Kassen?rztliche Vereinigung) and determined the patients' free choice among licensed sickness fund physicians.     

A "concerted" approach to health care financing in the Federal Republic of Germany.

An overview is given on how the German health care system is financed, on the 'concerted action approach to health care' and on the long-term perspectives of the statutory sickness fund system as the very heart of the financing system. In all three parts the effects of different ways of financing on the allocation of health care resources and their distributional effects are dealt with. As the concerted action appears as a 'third way' between a pro-competition strategy and a governmental approach to health care and differs from the way other countries organize the allocation of health care resources it is given special emphasis.     

Methodische Überlegungen für das Datenlinkage von Primär- und Sekundärdaten im Rahmen arbeitsepidemiologischer Studien

Within the scope of an aging population, the topic age, work and health becomes more and more important. So far, research in occupational epidemiology utilizes various primary or secondary data sources. However, data linkage has rarely been used as an instrument in this field. The study presented here combines two large databases within a so-called “age–work matrix”, stratified by sex, age group and occupational group. This matrix is based on the German classification of occupations and uses its occupation codes as a key variable. The first database is the representative BIBB/BAuA employment survey for employees of all occupations in Germany 2005/06. The second database consists in sickness absence data of the insurees of a German statutory health insurance fund. Using the matrix approach, the study investigates associations of reported subjectively perceived psychosocial work strains and health impairments provided by health insurance claims data. These claims data offer sickness absence data as an indicator for health impairments. Usability of sickness absence data for studies in occupational epidemiology, their methodological challenges and the solutions realized in this study are discussed.     

Association Between Dentist–Dental Hygienist Communication and Dental Treatment Outcomes

Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist–dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist–dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist–dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist–dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.     

Nationwide survey of dentist recruitment and salaries in community health centers

Recruitment of dentists continues to be a problem in community health center (CHC) dental practices. This study was carried out to quantify the scope of the problem and to determine CHC dentist salaries and benefits. Community health center executive directors nationwide were surveyed regarding dentist vacancies, recruiting issues, and salary and benefit information. Of 345 surveys mailed, 159 responses were received (46.1%). Slightly fewer than half of the responding executive directors (47.8%) reported one vacant dentist position. An additional 11.9% of executive directors reported a second vacancy. The overall vacancy rate was 17.6%. Median salaries ranged from 78,000 dollars for entry-level dentists to 90,000 dollars for dentists with 10 or more years of experience, not including benefits. There are difficulties in recruiting dentists to CHC dental practices. Mean salaries in CHCs are slightly higher than in academic positions, but less than in private practice employment or ownership. Caution should be used when comparing salaried positions with substantial benefits to self-employment or sole proprietorships.     

Risk structure compensation in Germany's statutory health insurance.

In 1996 insurees in Germany's statutory health insurance system were given a right to choose their sickness fund. To ensure that all funds had an equal starting position, a risk structure compensation scheme based on income and average expenditure by age and sex was introduced. From an analysis of expenditure and transfers, data on sickness fund membership and a published survey, the following effects can be identified: sickness funds merged, with a reduction in number from 1,221 to 420 between 1993 and 2000; the risk compensation scheme narrowed differences in contribution rates; insurees left the more expensive funds for cheaper ones; and increasing transfer sums indicate further risk segregation. Thus, the compensation mechanism will have to be retained permanently, although modifications are likely.     

A health survey and a survey of family physician house calls among Turkish and Dutch residents of Rotterdam]

This paper reports the results of a study of the health situation of Turkish and autochthonous citizens of Rotterdam (Holland). A health interview survey was held with a random sample of 250 Turkish citizens (age 19-69) and a matched group of 250 autochthonous citizens. With ten percent of the respondents a second, in-depth interview was held. With regard to (reported) presence of chronic diseases and to diseases in the two weeks preceding the interview no differences were found between Turkish and Dutch respondents. Turkish respondents answered less positively on questions that refer to subjective aspects of health. Turkish respondents consulted their general practitioner more frequently (RR = 2.62) and the dentist less frequently (RR = 0.61) than Dutch respondents. Little differences existed in frequency of visits to the medical specialist or in frequency of hospital admissions. With some caution, it may be concluded that the frequent visits to the general practitioner by Turkish respondents do not follow from differences in physical problems, but from cultural differences in the attitude towards the general practitioner.     

Attitudes and risk perception of parents of different ethnic backgrounds regarding meningococcal C vaccination

The aim of the present study is to assess the attitudes of parents toward vaccination as well as their risk perception of disease and vaccination. We interviewed 1763 parents of different ethnic groups (among others, Dutch, Turkish, Moroccan, and Surinamese parents). Results show that there were large differences in knowledge about disease and risk perception of disease and vaccination among parents of different ethnic backgrounds. Generally, people largely overestimated the risk of contracting the disease and the risk of dying after contracting the disease. Dutch parents were best informed, least worried, had the most critical attitude toward the campaign, and the lowest vaccination level compared to other parents. The differences in knowledge about vaccination and the more critical attitude of Dutch parents emphasize the need to take more into account parents' perspectives when designing information leaflets or other information media.     

Income-related inequality in the use of dental services in Finland

The aim of this article is to measure and explain income-related inequalities in dentist utilisation. We apply concentration and horizontal inequity indices and the decomposition method to decompose observed inequalities into sources. The data are from the Finnish Health Care Survey of 1996. We examine three measures of utilisation: (a) the total number of visits; (b) the probability of visiting a dentist; and (c) the conditional number of positive visits for (i) visits to all dentists, (ii) those to public dentists and (iii) those to private dentists. The results for the whole sample show pro-poor inequities in all three measures of utilisation in public care, whereas in the first two measures there are pro-rich inequities nationwide and in private care. Among those entitled to age-based subsidised dental care, we find equality and equity in all three measures of utilisation nationwide. The two main factors related to pro-rich distributions of use are income and dentist's recall. To enhance equity in dental care across income groups, attention should be focused on supply factors and other incentives to encourage the poor to contact dentists more often.     

Understanding and improving communication and decision-making in palliative care for Turkish and Moroccan immigrants: a multiperspective study

Objective. The aim of this study is to explore how communication and decision-making in palliative care among Turkish and Moroccan patients is influenced by different styles of care management between Turkish and Moroccan families and Dutch professional care providers. Problems as well as solutions for these problems are highlighted. Design. A qualitative design was used, totally interviewing 83 people (6 patients, 30 relatives and 47 care providers) covering 33 cases of incurable cancer patients receiving palliative care. Data were analysed thematically and contextually. Results. The analysis reveals that problems in decision-making are partly related to differences in ethnic-cultural views on 'good care' at the end of life: Dutch palliative care providers prefer to focus on quality of life rather than on prolonging life, while Turkish and Moroccan families tend to insist on cure. Another barrier is caused by conflicting views on the role of the 'care management group': Dutch care providers see the patient as their primary discussion partner, while in Turkish and Moroccan families, relatives play a major part in the communication and decision-making. Moreover, the family's insistence on cure often leads to the inclusion of additional care providers in communication, thus complicating joint decision-making. Conclusion. Care providers need to understand that for Turkish and Moroccan patients, decision-making is seldom a matter of one-to-one communication. Next to acknowledging these patients' different cultural backgrounds, they must also recognise that the families of these patients often function as care management groups, with an 'equal' say in communication and decision-making. In addition, professionals should optimise communication within their own professional care management group.     

Switching sickness funds and risk compensation mechanisms in the statutory health insurance system in Germany--empirical results from the cooperative health research in the region of Augsburg (KORA)

Since 1996, all citizens of the Federal Republic of Germany who are insured in the statutory health insurance system are entitled to switch their sickness fund. The rationale of this regulation was to strengthen elements of competition in this system in order to stimulate the sickness funds to improve the efficiency of health care and to respond to consumers' preferences. Simultaneously, to avoid the implicit incentives for sickness funds to engage in risk selection, a risk compensation mechanism was introduced, including as morbidity-related risk adjusters age, sex and incapacity to work. Based on the KORA survey S4 (1999/2001) we take the case of switching behaviour in the region of Augsburg, and analyse whether this risk adjustment scheme was working effectively. The results show that persons changing their sickness fund were characterised by a comparatively smaller burden of chronic diseases and by a less frequent utilization of inpatient health care. Under these conditions, differences in the contribution rates do not accurately reflect differences in the performance and efficiency of sickness funds. Moreover, the migration of good risk to sickness funds with favourable contribution rates threatens the principle of financial solidarity. Therefore, the system of risk equalisation has to be developed towards measuring the risk volume borne by the sickness funds more precisely than hitherto.     

The German health care system and health care reform

This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.     

警察艾滋病防治知识水平与态度取向关系

目的 了解警察艾滋病防治知识水平和态度取向的基本情况及两者之间的关系.方法 采用自行设计问卷,以匿名方式对广西南宁市505名警察进行现况调查,使用多分类多元Logistic回归进行统计分析.结果 艾滋病防治生物性知识平均得分为 (12.17±2.36)分,政策性知识平均得分为 (3.02±1.73)分;对针具交换 (NSE)和美沙酮维持治疗 (MMT)的支持率约为74%左右;有57.8%的警察表示愿意与艾滋病感染者来往;有>90%的警察表示愿意参加自愿咨询检测 (VCT)和坚持使用安全套;Logistic回归分析结果显示,随着艾滋病防治知识的丰富,持不知道态度的人数减少,但对VCT和与艾滋病感染者交往持否定态度者却不因为知识的丰富而转变态度.结论 南宁市警察艾滋病防治知识培训尤其是政策性知识培训仍然有待加强.对持否定态度的警察,还应采取其他方式进行引导和教育.