Die ökonomische Evaluation von Gesundheitsleistungen gewinnt insbesondere für die ältere Zielgruppe zunehmend an Bedeutung. Dabei spielt die Kostenermittlung eine zentrale Rolle. Häufig ist dazu eine Erfassung gesundheitsbezogener Ressourcenverbräuche durch Selbstangaben aufgrund der Vielzahl an Kostenträgern unumgänglich. Aus diesem Grund wurde ein Fragebogen entwickelt, mit dem die Inanspruchnahme von Gesundheitsleistungen aus gesamtgesellschaftlicher Perspektive erfasst werden kann. Die monetäre Bewertung der im Fragebogen erfassten Einheiten stellt einen wichtigen Schritt zur Ermittlung der Kosten dar. Der Beitrag zeigt und diskutiert die Ermittlung der entsprechenden Bewertungssätze für die im Fragebogen erhobenen Einheiten von Gesundheitsleitungen aus der gesamtgesellschaftlichen Perspektive.
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Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients' perspectives is helpful.
Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called "objective" characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016.
Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients' subjective urgency and different items for objective care.
Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients' perceived urgency may affect the disposition, rapidness of the service and transport targets.
