Background
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There is a mandatory basic health insurance for everyone, purchased through private insurers (both profit and not-for-profit are possible);
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There is annual consumer choice of insurer and insurer products and choice between in kind and restitution policy;
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Insurers are obliged to have a system of open enrollment and are compensated via a risk-equalization system;
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There is a mandatory deductible of € 150 and avoluntary deductible up to € 650 per person per year;
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Insurers are expected to contract selectively with competing health care providers;
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The government requires health care providers to release quality information.
Methods
Available data
Quality aspects
| 2006 | 2007 | 2009 |
---|---|---|---|
Physician communication | 4 | 4 | 4 |
Nurses communication | 4 | 4 | 4 |
Pain treatment | 3 | 3 | 3 |
New medication communication | 5* | 2 | 2 |
Accommodation | 4* | 5 | 5 |
Treatment explanation | 3 | 3 | |
Feeling safe | 5 | 5 | |
Respect for autonomy | 7 | 7 | |
Contradictive information | 3 | 3 | |
Discharge information | 7* | 8 | 8 |
Ward intake experience | 4 | 4 | |
Intake conversation* | 15* | 12* | |
Hospital accessibility | 3 | 3 | |
Nurse services* | 3* | ||
Intervention planning* | 3* |
Primary analyses and publication
Secondary statistical analyses
Results
Respondents
Respondents | Non-respondents | |
---|---|---|
2006 (n) (31 hospitals) | 8,311 | unknown |
% Male 2006 | unknown | unknown |
Avg. age 2006 | 61 | unknown |
2007 (n) (78 hospitals) | 22,333 | 14,190 |
% Male 2007 | 42% | 42% |
Avg. age 2007 | 61 | 63 |
2009 (n) (94 hospitals) | 24,246 | 18,009 |
% Male 2009 | 43% | 42% |
Avg. age 2009 |
60*
| 72 |
Change in performance over time
Quality aspects
| 2006 | 2007 | 2009 | |||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | |
Physician communication | 3.43 | 0.57 | 3.41 | 0.58 | 3.49 | 0.52 |
Nurses communication | 3.39 | 0.64 | 3.45 | 0.64 | 3.53 | 0.55 |
Pain treatment | 3.49 | 0.65 | 3.46 | 0.66 | 3.45 | 0.67 |
New medication communication | n/a | 3.05 | 0.96 | 2.98 | 0.95 | |
Accommodation | n/a | 3.29 | 0.53 | 3.25 | 0.54 | |
Treatment explanation | n/a | 3.47 | 0.70 | 3.52 | 0.65 | |
Feeling safe | n/a | 3.35 | 0.63 | 3.43 | 0.59 | |
Respect for autonomy | n/a | 2.97 | 0.64 | 3.02 | 0.64 | |
Contradictive information | n/a | 3.45 | 0.96 | 3.43 | 1.00 | |
Discharge information | n/a | 3.20 | 0.88 | 3.15 | 0.88 | |
Ward intake experience | n/a | 3.88 | 0.43 | 3.87 | 0.40 | |
Hospital accessibility | n/a | 3.48 | 0.76 | 3.49 | 0.73 |
Coefficients per quality aspect**** | Year 2007 (compared to 2006) | Year 2009 (compared to 2007) | Publication of results |
---|---|---|---|
Physician communication # **** |
-0.039 **
| 0.014 |
0.032*
|
Nurses communication# |
0.049 **
|
0.112 ***
| 0.021 |
Pain treatment# |
-0.050*
|
-0.062 **
| 0.033 |
New medication communication | n/a | 0.024 | 0.086 |
Accommodation | n/a |
0.090***
|
0.045**
|
Treatment explanation | n/a |
0.069 ***
| 0.033 |
Feeling safe | n/a |
0.220 ***
| 0.025 |
Respect for autonomy | n/a |
0.131 ***
| 0.033 |
Contradictive information | n/a |
0.056 ***
| 0.026 |
Discharge information | n/a | 0.010 | 0.026 |
Ward intake experience | n/a |
0.027 **
| 0.077 |
Hospital accessibility | n/a | 0.026 | 0.016 |
Coefficient of combined quality aspects | Year 2007 | Year 2009 | Publication of results |
---|---|---|---|
Quality aspects 1-3**** years 2006/2007/2009 | -0.011 |
0.034 *
|
0.030 *
|
Quality aspects 4-12 years 2007/2009 | n/a |
0.060***
|
0.027**
|
Performance and level of competition
Coefficient of combined quality aspects | HHI |
---|---|
Quality aspects 1-3# **** |
-5.42 10
-6
***
|
Quality aspects 4-12 |
-4.89 10
-6
***
|