Empowering Doctors in Their own Practices Would Make More Sense
The authors discussed handling good data and poor data on the one hand, but on the other hand they elevated a relatively weak—in my view—non-randomized observational study into the subject of the title (1).
Said study dealt with the long term results of a pilot project of “integrated healthcare provision,” in whose evaluation the authors themselves defined the quality indicators. In the end they did not confirm an improvement in the quality of care. The second objective of the study—namely, greater cost effectiveness by alleviating the burden on doctors/health insurers—was not addressed at all, in my opinion. They authors merely mentioned that the health insurers saved some 5 million Euros, which matched the cost of implementing the project.
These data constituted the blueprint for a nearly identical project (“Gesundheit für Billstedt/Horn”) in Hamburg, in the context of which nursing staff, midwives, and geriatric nurses provide easy-access advice to patients in a so-called health kiosk. To this end, the project operators/partners received 6.3 million Euros in start-up finance for the first three years from the innovation fund of the German federal government. In the first year, about 3000 sessions (about 10/day) were provided. According to the final project report, 40% of these sessions were for obesity, for which innovative courses such as “Yoga for Chubbies [chubby people]” were offered, among others.
Even though reforming our healthcare system and strengthening the outpatient sector, with an associated reduction in inpatient services, fundamentally makes sense, I ask myself why, rather than funding such cost intensive projects of private enterprises, doctors in their own practices could be supported and strengthened—for example, by more attractive working conditions and appropriate payment for outpatient services. Even now, a doctor in their own practice as a rule consults and treats notably more patients, and—owing to their specialist knowledge—probably with a higher degree of quality and a notably wider range.
PD Dr. med. Volker Schmitz
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Schubert I, Stelzer D, Siegel A, et al.: Ten-year evaluation of the population-based integrated health care system „Gesundes Kinzigtal“. Dtsch Arztebl Int 2021; 118: 465–72 VOLLTEXT|