Biomedical subjects
K Obermann
Publications and source records attributed to K Obermann.
[Rationing in medicine from the economic viewpoint].
The rationing of medical care is inevitable. The economic term "rationing" describes in a value-neutral manner that goods and services have to be withhold if financial means are limited. A changing demographic structure of society, rising expectations of patients as well as relatives and medical-technological progress are the main reasons for the rising rationing pressure and these developments can, if at all, be influenced only to a minor degree. Rationalization, i.e. to increase efficiency is a prerequisite before any rationing should be initiated and it often combines cost-savings with improved patient care. Rationalisation, however, cannot render rationing unnecessary. Rationing should take place in an explicit manner, with open discussions and comprehensible modes of discussion. One has to ask, a) which ideas about justice prevail in a society, b) which philosophical theory could provide a widely accepted and coherent basis for a rationing calculus and c) how a theoretical model can be transformed into applicable social politics and decision modes.
Some politico-economic aspects of organ shortage in transplantation medicine.
Transplantation of solid organs has become a widely performed and accepted procedure. This type of high-performance medicine has led to vigorous debates on ethical and economic issues and most of this discussion can be seen as an example of the different opinions about highly individualised and technologised approaches in health care. The paper focuses on the rising gap in the demand for suitable organs for transplantation and the levelling off, or even fall, in the supply of these organs. Despite the rather demanding requirements for organ donation, there appear to be a sufficient number of deaths under suitable circumstances to satisfy the annual demand of transplantable organs--if the collection rates are adequate. It has been shown that there are great differences in the rate of organ procurement efficiency within different regions. The question then is how to set appropriate incentives to obtain organs in sufficient quantities from eligible donors to meet the demand. This paper discusses the different medical and societal approaches as well as the economic proposals to overcome the organ shortage. The theory of Public Choice is used to develop a specific policy that can be applied to organ procurement efforts. This is a different approach, whereby political and economic considerations of ethical dilemmas focus on setting appropriate and widely accepted frameworks and rules, in which individuals may then decide about their behaviour. In an appendix, the economic consequences of transplantation medicine are discussed if more organs were to be made available and the impacts of relaxing the simplifying assumptions on effectiveness of organ replacement therapy and on the allocation system are considered. Ultimately, artificial organs or genetically transformed animal organs may be used but it is highly likely that a vigorous debate on the ethics and especially financial implications of these interventions will take place beforehand.
[Economic analysis of secondary prevention of coronary heart disease with simvastatin (Zocor) in Germany].
BACKGROUND: Coronary artery disease (CAD) has enormous financial, medical, as well as economical consequences in Germany. Important risk factors include raised total cholesterol and LDL cholesterol blood levels. The 4S Study has demonstrated the clinical effectiveness in the secondary prevention of CAD. METHOD: Based on the health economics data of this study, we undertook a cost-effectiveness analysis of the secondary prevention of CAD with simvastatin in Germany. RESULTS: On average, the costs per life year gained were DM 18,500.-(sensitivity analysis: DM 9,340.- to DM 29,374.-). The consequences of this result are discussed. CONCLUSION: It is necessary from a health economists' point of view to assess the efficiency of a clinically effective measure in a standardised manner. This permits a comparison of efficiency with other, competing forms of health care, which is necessary in areas like CAD where there are different approaches to combat the disease. Simvastatin is highly efficacious in the secondary prevention of CAD in a defined patient population and, in comparison to other interventions in this area, it also proves to be cost-efficient.
Some aspects of justice in the allocation of organs for transplantation.
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[Aspects relevant for abdominal surgery of attempted suicide].
In this retrospective study of 24 patients who were treated at our clinic during the last 22 years after having attempted suicide, we evaluated aspects concerning abdominal- and transplantation surgery. There was a predominance of "hard" (70%) versus "soft" (30%) methods for suicide attempt. Intra-abdominal injuries resulting from attempted suicide by stabbing or shooting should lead to laparotomy-the prognosis is then good. Surgical treatment after intoxication, especially caustic ingestion, depends on endoscopic and clinical findings. The highly increased rates of suicide in patients with end-stage renal disease can be reduced significantly by kidney transplantation. The risk of suicide after transplantation is further diminished with improved immunosuppressive treatment. Only in a few cases there is an indication for liver transplantation-in some cases of fulminant hepatic failure caused by self-administered paracetamol overdose. Auxiliary liver transplantation may then be considered.
[Economic aspects of oncologic surgery: what do we know, are they relevant; must--may--we regard them?].
Economic aspects of medical care play an increasingly more important part in evaluation of diagnostics and therapeutics. Therefore it seems necessary to examine the present studies and their results carefully. In meta-analysis of cancer care, different techniques of economic analysis are used. Stage-specific analyses of direct costs in patients with colorectal neoplasms show a major influence of the stage at diagnosis on total costs of initial care. In contrast to this, increased age and increased comorbidity of patients did not function as a cost increasing factor in each stage of the disease. Net costs, that is attributable costs, are the difference between costs of the care of each subject and the average costs of controls. Net costs of continuing care decreased with age in patients with colorectal neoplasms. Cost-effectiveness analyses in patients with colon and breast cancers demonstrated lower medicare payments per year of survival for tumors diagnosed at earlier stages. From the date presented, no relevance of health economic aspects on individual planning of therapy can be deduced. Health economic aspects are appropriate in order to develop guidelines and are a basis of discussion at the level of macro-allocation. They can be used in the scope of a multi-dimensional evaluation of a new treatment and serve medical and therapeutic definitions of goals.
Ethical considerations in procuring organs from non-heart-beating donors after sudden cardiac death.
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[The 1995 federal health regulation: new forms of hospital financing].
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Cohabitation and pregnancy-induced hypertension.
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Incisor mamelon morphology: diagnostic indicators of abnormal development.
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