背景:自2000年《世界卫生报告》以来,建立了卫生系统绩效评估(HSPA),作为对卫生系统进行评估和循证治理的工具。到目前为止,人口观点尚未系统地纳入HSPA,尽管人们的经验和期望对于改善卫生系统,特别是加强以患者为中心的护理非常重要。因此,这项研究旨在从人口的角度对德国卫生系统进行HSPA,涵盖世卫组织卫生系统框架的所有八个目标,并确定改进的优势和需求。
方法:2018年,通过邮件邀请了32,000名获得德国疾病基金“AOKNordost”保险的人参加调查。问卷共包含43个项目,涵盖世卫组织卫生系统框架的八个目标(例如,access,质量,安全)加上被保险人的社会经济学和其他特征。对卫生系统目标的数据进行了描述性和亚组分析(年龄,性别,收入,慢性疾病,健康素养)。
结果:样本(n=1,481;反应率4.6%)为54.8%的女性,平均年龄为59.1岁(±18.5)。总之,参与者看到了德国卫生系统内部的一些改进需求。例如,60.0%的人发现医院之间的质量差异很大,3.9%至8.5%的人报告了前两年与治疗或处方药有关的错误。特别是在自付费用(51.5%)以及门诊医生彼此之间(44.2%)和与医院(41.9%)的协调方面,需要进行改革。此外,观察到大的亚组差异,特别是收入和健康素养。在低收入群体的参与者中,37.2%的人报告说,由于自付付款,(非常)沉重的财务负担(与20.7%)。健康素养有限的人(52.1%)通常认为获得护理的机会不好,他们意识到更大的质量差异和改革需求,与他们的同行相比。例如,36.6%的人在前一年经历过歧视(与19.9%)。
结论:调查结果从人口角度全面了解了德国的卫生系统。在某些地区,先前的发现得到了证实(例如,提供商之间缺乏协调)。其他结果扩展了现有知识(例如,健康素养在医疗保健提供中的作用)或提出新的问题(例如,来自自付费用的主观评估负担与目前使用的客观措施之间的差异)。小组之间的巨大差异是在政治和实践层面上采取行动的呼吁,以更好地考虑个人的需求,从而使每个人的健康更好。进一步的研究可以在这方面提供更深入的见解。
结论:加强HSPA中的人口观点可以更好地理解和评估卫生系统,特别是,有助于确定以患者为中心的护理需要改进的地方。
BACKGROUND: Since the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people\'s experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany\'s health system from the population\'s perspective covering all eight goals of WHO\'s Health Systems Framework, and to identify strengths and needs for improvement.
METHODS: In 2018, 32,000 people insured with the German sickness fund \'AOK Nordost\' were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO\'s Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy).
RESULTS: The sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%).
CONCLUSIONS: The survey results provide a comprehensive picture of Germany\'s health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual\'s needs in order to make health better for everyone. Further research could provide deeper insights in this regard.
CONCLUSIONS: Strengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.