Versorgungsstrukturen und Qualitätssicherung für Prävention und Gesundheitsförderung in Deutschland

Abstract

In order to identify requirements of quality assurance in this field, a general description of prevention, health promotion and education is outlined, based upon healthcare supply analyses and 158 interviews with experts. Prominent features are, among others, a distinctive heterogeneity and complexity of settings, suppliers, and interventions; supply of coverage is below public health criteria (needs); weak outcome evaluation; competition among suppliers, providers, and political agencies and decision makers; need for intra- and intersectoral coordination; the lack of evidence-based healthcare planning; and hurdles for quality assurance. A structural taxonomy of quality assurance systems is then developed, consisting of three dimensions: validity (quality of information), regularity, and degree of commitment and obligation. In terms of these dimensions, important systems of quality assurance in prevention, health promotion and education in Germany are analyzed. A number of different systems and approaches can be found. However, most of them share questionable validity, regularity, and degree of obligation. Increased commitment on behalf of providers, suppliers, and political institutions and decision makers for the quality of preventive interventions is inevitable in order to raise the performance of prevention and health promotion in Germany to their potential effectiveness.

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“…• Plethora of programs: Even professionals find it hard to maintain an overview of the plethora of programs and select the most appropriate programs for a specific case (Kliche 2011). An (incomplete) search revealed at least 419 primary prevention programs for children in Germany alone (Gerlach et al 2009;Noweski 2009).…”

“…Compared to the clinical sector, prevention research suffers from structural weakness and underfunding in combination with heterogeneous work settings that place high demands on research planning (Kliche 2011). However, stringent designs are likely to evoke resistance in some fields because practitioners as well as funding agencies feel they are being monitored by robust evaluations that enable comparison.…”

“…• Choices based on marketing criteria instead of effectiveness: Research gaps, complexity and unclear implementation conditions encourage the use of irrelevant selection criteria like the public visibility of decision-makers and their agencies, the image and customer loyalty of health insurance companies, and personality profiling of managers (Bertozzi et al 2008;Kliche 2011). Competition between funding agencies additionally leads to the unconnected and uncoordinated implementation of programs, resulting in the inclusion of non-target groups, which spoils the effectiveness of the programs.…”

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