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Management im GesundheitswesenBusse R, Blümel M, Scheller-Kreinsen D, Zentner A (2009): Managing chronic disease in Europe. In: The Initiative for Sustainable Healthcare financing in Europe (2nd report)

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Managing chronic disease in Europe. In: The Initiative for Sustainable Healthcare financing in Europe (2nd report) Securing Europe’s healthcare future: Chronic disease management. Prague, February 2009

Prof. Dr. Reinhard Busse, Miriam Blümel, David Scheller-Kreinsen, Dr. Annette Zentner



Chronic conditions and diseases are the leading cause of mortality and morbidity in Europe, accounting for 86% of total premature deaths, and research suggests that complex conditions such as diabetes and depression will impose an even greater health burden in the future. The epidemiologic and economic analyses suggest that policy makers should make disease management a priority. But choosing the right strategies will be difficult, particularly given the limited evidence on effectiveness and cost-effectiveness. Policy makers need more than academic evidence on individual interventions; they also need to know which institutional and organisational conditions favour successful chronic disease management and where the gaps in knowledge need to be closed.
“With this report, we are highlighting five dimensions of managing chronic disease where policy makers must act: Pharmaceutical & medical innovation, financial incentives, coordination, information & communication technology, and evaluation” underlines Prof. Dr. Reinhard Busse, Dpt of Healthcare Management - Berlin University of Technology. Among other proposals, the report suggests:

  • The development of personalised medical treatments is an important trend for the future of chronic disease management. However, using specialized treatments to manage chronic disease brings a new set of problems. In particular, policy makers need to consider how to organize effectively licensing and reimbursements for personalised medicine.
  • Financial incentives are important but encouraging a few narrow goals can lead to excessive focus on these goals, together with “gaming” or better reporting without any improvements in quality. Policy makers should set out quality indicators that reflect different aspects of quality (structure, process, and, where possible, outcome).
  • Patients’ perception of the quality of care is largely determined by successful coordination. However, policy makers must recognise that well-organised interests tend to benefit from fragmented care, so reforms aimed at improving coordination should be well-prepared, and supported by strong political will.
  • Agreeing on technical standards for information technology is essential because one of the key challenges is to achieve functional interoperability within health systems. Policy makers should get those involved together and ensure that they agree on goals and standards.
  • Evaluation should be an integral part of all efforts and programmes to improve the management of chronic disease.



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