Thanks to compulsory health insurance in Germany no citizen is without insurance cover. A mere eleven percent of the population are privately insured. Nevertheless, over the past decade the number of statutory health insurers has decreased significantly, mostly by way of mergers and acquisitions, and politically desired. Today, large and powerful insurance companies shape German healthcare. Several of these major insurers commissioned repeat surveys of their members to get a clearer picture of customer satisfaction with the medical services provided – and to distinguish themselves from the competition.
Between November 2011 and October 2012, two big players, AOK and Barmer GEK, surveyed about one million patients right after their hospital stay; 450,000 insured responded. The scientifically designed short questionnaire contained 15 questions regarding satisfaction with medical and care services and with the organisation of the hospital. Finally, the patients were asked whether they would recommend the facility. The results were integrated into the so-called ‘Weisse Liste’ (White List), an online portal created in 2008 by the not-for-profit and privately funded Bertelsmann Foundation and the umbrella associations of all major patient and consumer organisations. This portal allows patients in Germany to compare healthcare institutions and supports their search for a suitable hospital, physician or care facility.
In general, the patients were satisfied with the care they received: 82 percent of the surveyed would recommend their hospital; 83 percent were satisfied with the medical care and 82 percent were satisfied with the nursing care. At 79 percent, the satisfaction with hospital organisation and service was slightly lower. However, patients did notice significant differences between hospitals. ‘Two thirds of the facilities mentioned by the patients receive a positive rating of 80+ percent. The rest is lagging. 2.4 percent were rated below 70 percent, meaning they are recommended much less’, Jürgen Graalmann, Chairman of the Board of AOK Bundesverband explained, summing up the results when the survey was presented at a Berlin press conference. He also pointed out that younger patients tend to be more critical than older ones: while about 84 percent of the 60-80-yearold patients were prepared to recommend their institution, among the 20-40-year-olds the rate was only 75 percent.
No ‘soft’ data
The significance of patient experience is confirmed by a study headed by Felix Greaves, whose results were published in the February 2012 issue of ‘Archives for Internal Medicine’ (Associations Between Web-Based Patient Ratings and Objective Measures of Hospital Quality). ‘According to this study the patient evaluations of British hospitals correspond to a large extent with objective quality assurance results. For example, patients’ perception of a hospital’s cleanliness and the rate of infections with dangerous pathogens in this hospital, correlate. Thus, the argument that data derived from scientifically sound patient experience surveys are merely ‘soft’ data is clearly debunked,’ Gerd Billen, head of the umbrella association of the consumer protection organisations, said at the conference.
Online portals drive quality improvements
Patient evaluations are not only integrated into the hospital portal ‘Weisse Liste’ they are also an important feature of the websites maintained by the participating health insurers. A consumer-oriented glossary with 5,000 healthcare terms was created and today complements the information on the hospitals’ service portfolio and quality (www.aok.de/krankenhausnavigator, www.krankenhausnavi. barmer-gek.de).
German hospitals are required by law to report quality assurance data covering services areas and quality indicators with the aim to offer a transparent view of the quality of care. Service areas are, for example, breast cancer surgery and cardiac catheter interventions; quality indicators encompass inter alia the frequency of complications or the scanning time in X-ray imaging. These data provide an important foundation for the hospitals’ internal quality assurance and are complemented by quality assurance data developed by the AOK scientific institute. Thus information on severe and high risk pathologies with a high prevalence is routinely available; it includes data on the treatment procedures used and on standardised 30 days, 90 days and one year mortality rates, no matter whether the patient died in the hospital where he or she received initial treatment, in a different hospital or after discharge.
The data show which surgical interventions resulted in severe complications during standardised intervals or where repeat interventions were required, even when the follow-up is performed in a different hospital than that were the initial intervention was performed. Since the health insurers collect these data routinely no additional administrative effort is required. Thus the quality of medical services is quantifiable and made transparent on the AOK hospital portal: tree symbols indicate the quality of outcomes. ‘When surgery is required and can be scheduled the patient and referring physician should chose a quality-tested hospital,’ recommends Jürgen Graalmann, Chairman of the Board of AOK Bundesverband, underlining that the evaluation portals by the health insurers offer an important and easy to use decisionmaking tool.