Germany map of medical care

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New Internet portal offers an overview of medical interventions

The "Health facts check" portal, which is available online today, shows clear regional differences in health care. The Bertelsmann Foundation's Initiative for Good Health Care (INIgG) has documented a large number of different interventions and compiled them in a Germany atlas on health care.

The map material on the portal that went online today shows that health care across Germany depends significantly on where you live. On behalf of the Bertelsmann Foundation, the renowned IGES institute from Berlin had certain medical treatments such as Caesarean section deliveries, tonsil removal or appendix removal in children and adolescents, removal of the uterus, prostate, gall bladder or heart bypass surgery in adults detected. The compilation of the results on the new online health care portal illustrates the enormous regional differences in health care in Germany.

Some differences are quite desirable, since they do justice to regional peculiarities, such as the different average ages of the population or the occurrence of certain diseases, the experts at the IGES Institute explain in the accompanying report. However, other deviations cannot be explained medically or on the patient side, so that the researchers encourage a closer examination of the causes. Although the scientists are extremely cautious in their attempted explanations, individual statements suggest that economic reasons could also play a role in the regionally different interventions. According to the experts, there are regional imbalances in care that cannot be explained by medical arguments, age and social structure - there is a certain arbitrariness.

Regional differences in Caesarean section deliveries For example, the number of Caesarean section deliveries is particularly high in the West Eifel region, but very low in the Chemnitz region. Normally, Caesarean section deliveries are a clear indication of possible risks to mother and / or child during a natural birth (spontaneous delivery). However, according to the experts, the different numbers indexed according to age groups of mothers and 1,000 live births do not suggest that mothers and babies in the West Eifel and Saxony are at different risk levels. Rather, this expresses a different attitude towards Caesarean section deliveries in the two regions. Because in individual cases a caesarean section is a weighing decision, unless "absolute indications" such as premature detachment of the placenta or irregular heartbeats of the child speak for such an intervention, the experts explained. For example, the more soft weighing factors include multiple pregnancies. But the staffing levels in the clinics can also lead to the fact that a planned delivery by Caesarean section is preferred to the spontaneous delivery, according to the report in the IGES Institute. In some cases, “wishful births would also be brought about if, for example, the child was to be born on Grandma's birthday,” the experts continued. In addition, the fear of the pregnant woman of natural birth could also be the reason for an increased number of Caesarean sections. According to the new online portal, liability issues also play a role in the decision to have a caesarean section, as the more controllable births are more likely to be used in smaller wards with fewer births per year and with fewer staff than in the large medical centers and clinics. All of these factors mean that the region with the most Caesarean sections has two and a half times as many Caesarean sections as the region with the fewest Caesarean sections.

No rational justification for regional care differences According to the figures for the initiative for good health care, these rationally incomprehensible regional care differences can also be seen in other medical interventions. For example, the removal of the tonsils (tonsillectomy) in children and adolescents According to portals, there are clear regional differences. Here, the factor between the region with the most and the region with the fewest interventions is as high as 8.3, report the experts from the IGES Institute. According to this, the least almond removal is carried out in the district of Steinburg an der Elbe, the region of Erfurt and Tübingen as well as south of Munich and in Middle Franconia, by far the most in the district of Schweinfurt. Here, the experts explicitly point out that economic interests may play a role in the different number of interventions. For example, small ENT departments could recommend tonsillectomy more often, since a sharp decline in the number of interventions would jeopardize the economics of the department, the experts suspect. The tonsils in children are actually only removed if there are frequently recurrent purulent tonsillitis or the airways are narrowed. Because although it is a relatively common procedure, the operation also involves health risks, such as the risk of uncontrolled bleeding. However, the balance between the advantages and risks seems to be significantly different in the different regions.

Map covers 16 common treatment areas These differences are precisely shown by the Bertelsmann Foundation in the new portal, so that the patients can inform themselves independently about the regional deviations. So far, the foundation has provided data on 16 common areas of treatment, such as Caesarean sections, removal of tonsils or appendix from children and adolescents, psychiatric care for adolescents and removal of the uterus, prostate and gall bladder in adults. Information about bypass surgery on the heart, implantation of a defibrillator, first implantation of a knee joint, groin and umbilical hernia surgery, hospital cases due to diabetes or depression can also be accessed on the new portal. In addition, further evaluations are planned, for example on the use of antibiotic therapies in children, the experts report. With the help of the online portal, patients should be made aware of the different regional health care systems and should be able to see for themselves before an intervention "how the indicators for health care in (their) region are", emphasized the Bertelsmann Executive Board member Foundation, Brigitte Mohn. Critical inquiries cannot hurt at this point, because "these differences can (or may be) an indication that patients sometimes receive medical services that they may not need at all," continued Mohn.

According to the board member of the Bertelsmann Stiftung, the regional differences have been known for a long time, because in 2001 the expert council for assessing the development in the health sector complained that valuable therapeutic resources would be unnecessarily used due to the regionally varying treatment preferences. Regionally different contract modalities, a lack of therapy guidelines and the presence or absence of specialized clinics are the main reasons why certain therapies are chosen particularly frequently or particularly rarely. According to the expert, the Rheinisch-Westfälisches Institut für Wirtschaftsforschung in Essen has estimated the resulting additional costs in the health care system at ten billion euros per year. With the new internet portal "" this development should now be counteracted in the long term, according to the Bertelsmann Stiftung's reason for setting up the online offer. (fp)

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Health facts check

Image: Dieter Schütz /

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