Quality of health care in Germany: results of a pilot study to assess health system performance

Abstract Background Health System Performance Assessment (HSPA) is used as a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a systematic HSPA was piloted for Germany. The conceptual framework includes different dimensions, e.g., access, population health, efficiency, and quality of care. In the following, Germany’s performance is analysed in terms of quality of care. Methods Indicators to assess the dimension of quality of care were selected based on a systematic search of established instruments in national and international HSPA initiatives. Other criteria for the inclusion of indicators were data availability and international comparability. The indicators were evaluated in terms of their time trend (2000-2020) and in international comparison (e.g., Austria, Denmark, France). Results Overall, 17 indicators were selected to assess quality of care, of which two could not be analysed due to missing data. Indicators include, e.g., emergency readmissions after hospital stays, patient-reported medical errors, coercive measures in psychiatric wards, and in-hospital mortality. Trend analyses were possible for 14 indicators and most of them showed positive developments. In country comparisons, which were feasible for seven indicators, Germany mostly ranked below average. In-hospital mortality for acute myocardial infarction, e.g., was 8% in 2019 in Germany (other countries: 4%-7%) and has been stable since 2014. For stroke, Germany performs better and ranks three of five (6%; range: 5%-9%) in 2019. Conclusions Measuring quality of care for a systematic and comparative German HSPA was proven to be feasible. However, some indicators could not be mapped so far due to lack of data. The results give insights into quality measurements across different sectors and can support evidence-based policymaking. Key messages • In the first health system performance assessment (HSPA) for Germany, quality of care was evaluated over time (2000-2020) and compared to eight European countries using 17 indicators. • Measurement of quality was feasible, but data availability should be strengthened in the future as country comparisons were possible for only half the indicators and two could not be analysed at all.


Background:
Health System Performance Assessment (HSPA) is used as a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a systematic HSPA was piloted for Germany. The conceptual framework includes different dimensions, e.g., access, population health, efficiency, and quality of care. In the following, Germany's performance is analysed in terms of quality of care. Methods: Indicators to assess the dimension of quality of care were selected based on a systematic search of established instruments in national and international HSPA initiatives. Other criteria for the inclusion of indicators were data availability and international comparability. The indicators were evaluated in terms of their time trend  and in international comparison (e.g., Austria, Denmark, France).

Results:
Overall, 17 indicators were selected to assess quality of care, of which two could not be analysed due to missing data. Indicators include, e.g., emergency readmissions after hospital stays, patient-reported medical errors, coercive measures in psychiatric wards, and in-hospital mortality. Trend analyses were possible for 14 indicators and most of them showed positive developments. In country comparisons, which were feasible for seven indicators, Germany mostly ranked below average. In-hospital mortality for acute myocardial infarction, e.g., was 8% in 2019 in Germany (other countries: 4%-7%) and has been stable since 2014. For stroke, Germany performs better and ranks three of five (6%; range: 5%-9%) in 2019.

Conclusions:
Measuring quality of care for a systematic and comparative German HSPA was proven to be feasible. However, some indicators could not be mapped so far due to lack of data. The results give insights into quality measurements across different sectors and can support evidence-based policymaking. Key messages: In the first health system performance assessment (HSPA) for Germany, quality of care was evaluated over time  and compared to eight European countries using 17 indicators. Measurement of quality was feasible, but data availability should be strengthened in the future as country comparisons were possible for only half the indicators and two could not be analysed at all.

Background:
Although largely preventable, tooth decay (dental caries) is among the most common health conditions worldwide and contributes to substantial dental treatment expenditures. While Fluoride Toothpaste (FT) is considered an essential strategy for oral health prevention, its market price has been shown to vary substantially across various settings. Against this background, the present study aimed to develop a decision analytical model to evaluate the cost-effectiveness of FT in various settings.

Methods:
Leaning on WHO CHOICE methodology, evidence scoping and an expert consensus were facilitated to extract model input parameters which were then fed into cost-effectivenessanalyses (CEA) for FT. The cost-effectiveness of the interventions was expressed as cost per Disability-Adjusted Life Year (DALY) averted.

Results:
The CEA identified a high likelihood for FT to be a costefficient treatment strategy in settings with comparably low market prices for FT. FT was less likely to be a cost-efficient treatment strategy in settings with comparably high market prices for FT.

Conclusions:
The developed decision analytical model is suitable to inform policymakers about the extent to which FT represents good value-for-money under different market prices.

Key messages:
Fluoride toothpaste can provide high value for money as an oral health preventive strategy. Policymakers need to ensure the affordability of fluoride toothpaste in order to harvest relevant efficiency gains. Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government's goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters.
Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. The research question is: upon which conditions depends the variance in the density of community pharmacies in Europe? So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional