Care: Zip code decides on therapy

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Regional differences: Therapy often depends on the zip code

In the different regions of Germany, clear regional differences in some therapies, operations and diagnoses can be observed. The Bertelsmann Foundation regularly analyzes such differences for its “Health facts check”.

Negative effects for the patient It should actually be assumed that factors such as the type and severity of a disease or the age of a patient are decisive for the prescribed medical therapy. However, experts complain that this is not always the case and that circumstances such as the density of specialists or doctor's fees have an impact. Healthcare researcher Professor Gerd Glaeske from the University of Bremen says: "There are always differences that are astonishing." And such differences can also be found in the diagnoses. This has a negative impact on the patients, since they often do not receive adequate treatment. This would also result in unnecessary costs.

In some regions, almonds are removed eight times as often. The Bertelsmann Foundation regularly analyzes such differences for its “health fact check”. For example, it has been found that children in some regions remove almonds up to eight times more often than in other areas. For example, it was found that 109 out of 10,000 children underwent surgery in the Bavarian district of Schweinfurt, while only 14 in the Thuringian district of Sonneberg. In northeastern Germany, children were also prescribed antibiotics twice as often as in the south.

General practitioners prescribe antibiotics rather than pediatricians. The reasons for this are not necessarily that people in one area are healthier than others. "In individual cases, such differences can often not be explained exactly," says Glaeske. He goes on to say: "There are suspected factors, but hardly any evidence." For example, it is known that general practitioners are antibiotics, for example in the case of a viral infection; on average more senselessly prescribed than pediatricians or otolaryngologists. For example, 33 percent of general practitioners prescribed antibiotics for a non-purulent otitis media that rarely benefits from antibiotics. However, only 17 percent of pediatricians and only nine percent of the ear, nose and throat doctors who are probably the most competent in this area did so. Glaeske explained that more rural antibiotics were therefore used in rural areas, where the family doctor was the most visited.

Rapid increase in ADHD diagnoses According to the fact check, the number of ENT clinics in the respective region also plays a role in almond surgery. Children from circles in which there are several large facilities would be operated on more frequently. The influence of doctors in attention deficit disorder (ADHD) is also striking. "There was a rapid increase in diagnoses and medication prescriptions. The Würzburg area is particularly striking, ”says Thomas Grobe from the Institute for Applied Quality Promotion and Research in Health Care. In 2011, around 6.5 percent of boys aged between ten and twelve were prescribed an ADHD product, such as Ritalin, nationwide. In Lower Franconia the figure was 13.3 percent, more than twice as much.

Educational level and age of parents influence diagnosis Since ADHD medication is prescribed by child and adolescent psychiatrists and the number of specialists is manageable, relatively few of them could significantly influence the medication regulations in an area. The level of education and the age of the parents would also have an impact on the diagnosis of ADHD. "Children of unemployed parents are affected more often," says Grobe. "And there is evidence that children of younger parents have a higher risk of diagnosis."

The East is sicker than the West In the adult population, regional differences are primarily due to the age structure, says Uwe Repschläger, Head of Corporate Management at Barmer GEK: "The age difference is the absolutely primary factor in explaining that the East is much sicker than that West. ”The reason for this is the emigration of many young East Germans to the western federal states. “The‘ sickest ’federal state is Saxony, the‘ healthiest ’Baden-Württemberg.” The 80 chronic diseases, for which clear definitions have been defined in the course of the risk balancing of the health insurance companies, are particularly suitable for the analysis of regional differences. "43 percent of our policyholders have at least one of these diseases," said Repschläger. Grobe explained that cardiovascular diseases, for example, are increasing in the new federal states: "The inner-German border can be read from the high blood pressure diagnoses."

240 stays in clinics per 1,000 inhabitants The differences in the countries are also enormous with caesarean sections. In Saarland, a good 37 percent of women gave birth by Caesarean section in 2012, but only just under 24 percent in Saxony. The "health fact check" also found a connection with the socio-economic situation in knee joint operations. According to this, more people usually got an artificial knee joint in wealthy circles. In 2012, a total of 15.7 million patients came under the knife in the approximately 2,000 German clinics. This was a record figure of 300,000 times. According to the Organization for Economic Cooperation and Development (OECD) in Germany, 240 hospitalizations per 1,000 inhabitants per year treated more inpatients than in any other industrialized country.

Faith in technology and price structure as reasons "We have a high-performance system, but in some areas there is already a certain imbalance", says Professor Fritz Uwe Niethard, General Secretary of the orthopedic companies DGOOC and DGOU. One reason for this is the great belief in technology. "In some cases where an operation is scheduled, another treatment would be more appropriate at first." The price structure is another cause, as the example of spinal surgery shows. "Their number is currently increasing in dynamic motion, but this cannot be explained by the growing number of seniors alone." Studies would also show that many of the intervertebral disc operations are superfluous. A resident doctor would receive 120 euros per patient per year for conservative treatment with physiotherapy and painkillers. In contrast, around 12,000 euros would be paid for the operation.

German liability law also plays a role. Repschläger says: "It would be best not to set incentives for doctors in the future so that more rapid surgeries are better compensated." However, German liability law also plays an important role in addition to the financial aspect Role. “Often a doctor does a lot more out of concern for possible claims than he would have to with the symptoms at hand.” At this point Glaeske also sees an important starting point: “It would be nice if doctors who hear the hoofs again first on horses would think - and not immediately of zebras. "(ad)

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