Abstract
The number of older individuals with dementia will increase over the next years. Thus, there is an ongoing debate over how to face the challenges of financing their medical care and how to identify appropriate pharmacotherapies. Some empirical articles have elaborated on problems of inappropriate quality of care for patients suffering from dementia. They identified quality deficits due to missing information, qualifications and cooperation structures as well as the potentially negative impact of budget restraints that confront physicians. From an economic point of view taken in this paper, it seems necessary to analyse the problem as a case of “team production”. The conclusion indicates that enhancing cooperative structures for medical production is paramount and that all strategies building on cooperative behaviour need to be accompanied with well-defined means for financing the challenges of an aging society. Hence, “risk sharing” between social institutions and private savings is necessary and must be conveyed by political strategies that are aware of the impact of the ongoing aging process within all industrialised countries.
Similar content being viewed by others
Literatur
Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. Kooperation und Verantwortung. Voraussetzungen einer zielorientierten Gesundheitsversorgung. Bonn: 2007
BMFSFJ. Vierter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und Versorgung Hochaltriger — unter besonderer Berücksichtigung demenzieller Erkrankungen. Berlin: BMFSFJ, 2002
Melchinger H. Chronische Versorgungsdefizite. Deutsches Ärzteblatt 2007; 104: 3236–3237
Online-Befragung zur Versorgung von Demenzpatienten. Data on file, Janssen-Cilag GmbH, Neuss: 2007
Bickel H. Stand der Epidemiologie. In: Hallauer JF, Kurz A (Hrsg.). Weiβbuch Demenz. Stuttgart: Thieme Verlag, 2002: 10–14
Hallauer JF. Epidemiologie für Deutschland mit Prognose. In: Hallauer JF, Kurz A (Hrsg.). Weiβbuch Demenz. Stuttgart: Thieme Verlag, 2002: 15–17
Hallauer JF, Berger K, Ruckdäschel S. Nationale und internationale Untersuchungsergebnisse. In: Hallauer JF, Kurz A (Hrsg.). Weiβbuch Demenz. Stuttgart: Thieme Verlag, 2002: 20–23
Rychlik R. Gutachten über die Unterversorgung mit Arzneimitteln in Deutschland für den Verband Forschender Arzneimittelherzsteller e. V., Institut für Empirische Gesundheitsökonomie. Burscheid: 2007.
Black SE, Doody R, Li H et al. Donepezil preserves cognition and global function in patients with severe Alzheimer disease. Neurology 2007; 69: 459–469
Cummings JL, McRae T, Zhang R. Effects of donepezil on neuropsychiatric symptoms in patients with dementia and severe behavioral disorders. Am J Geriatr Psychiatr 2006; 14: 605–612
Demling J, Kornhuber J. Stand der Pharmakotherapie. In: Hallauer JF, Kurz A (Hrsg.). Weiβbuch Demenz. Stuttgart: Thieme Verlag, 2002: 40–47
IQWiG. Cholinesterasehemmer bei Alzheimer Demenz, Abschlussbericht A05-19A, Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (Hrsg.). Köln: 2007
Burns A, O’Brien J. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. Journal of Psychopharmacology 2006; 20: 732–755
McRae T, Knopman D, Duttagupta S, Ieni J, Provenzano G. Donepezil delays time to nursing home placement. Journal of the American Geriatrics Society 2001; 49: S132–S132
Feldman H, Kavanagh S, Brashear HR et al. Effect of Galantamine on time to residential or nursing home admission. 2004 Poster presented at the 8th European Federation of Neurological Societies
Cahill S, Clark M, O’Connell H et al. The attidues and practices of general practitioners regarding dementia diagnosis in Ireland. International Journal of Geriatric Psychiatry 2008; veröffentlicht bevor Druck. Online erhältlich.
Cahill S, Clark M, O’Connell H et al. Dementia in primary care: the first survey of Irish general practitioners. International Journal of Geriatric Psychiatry 2006; 21: 319–324
Turner S, Iliffe S, Downs M et al. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing 2004; 33: 461–467
Maeck L, Haak S, Knoblauch A et al. Early diagnosis of dementia in primary care: a representative eight-year follow-up study in Lower Saxony, Germany. International Journal of Geriatric Psychiatry 2007; 22: 23–31
Ingenhag W. Voraussetzungen aus Sicht der Gesetzlichen Krankenversicherung. In: Hallauer JF, Kurz A (Hrsg.). Weiβbuch Demenz. Stuttgart: Thieme Verlag, 2002: 123–126
Breyer F, Zweifel P, Kifmann M. Gesundheitsökonomik. Heidelberg: Springer-Verlag, 2005
Hamann J, Adjan S, Leucht S et al. Psychiatric decision making in the adoption of a new antipsychotic in Germany. Psychiatric Services 2006; 57: 700–703
Lundin D. Moral hazard in physician prescription behavior. Journal of Health Economics 2000; 19: 639–662
Dusheiko M, Gravelle H, Yu N et al. The impact of budgets for gatekeeping physicians on patient satisfaction: Evidence from fundholding. Journal of Health Economics 2007; 26: 742–762
Stoppe G, Pirk O, Haupt M. Treatment of Alzheimer’s disease utilising the best available evidence-based medicine — Utopia? Gesundheitswesen 2005; 67: 20–26
Peikert P. Richtgröβen und Richtgröβenprüfungen nach dem ABAG. Medizinrecht 2003; 21: 29–34
Schmid K. Richtgröβenregress — was nun? Deutsches Ärzteblatt 2007; 104: 3210–3212
Erlei M, Leschke M, Sauerland M. Neue Institutionenökonomik, 2. Auflage. Stuttgart: Schäffer-Poeschel, 2007
Holmstrom B. Moral Hazard and Observability. Bell Journal of Economics 1979; 10: 74–91
Macho-Stadler I, Pérez-Castrillo D. An Introduction to the Economics of Information, Incentives and Contracts. Oxford: Oxford University Press, 2001
Wolfs CAG, Dirksen CD, Severens JL et al. The added value of a multidisciplinary approach in diagnosing dementia: a review. International Journal of Geriatric Psychiatry 2006; 21: 223–232
Brayne C, Fox C, Boustani M. Dementia screening in primary care — Is it time? JAMA 2007; 298: 2409–2411
Salzman C. Medication compliance in the elderly. Journal of Clinical Psychiatry 1995; 56: 18–23
Brodaty H, Green A. Defining the role of the caregiver in Alzheimer’s disease treatment. Drugs & Aging 2002; 19: 891–898
Callahan CM, Boustani MA, Unverzagt FW et al. Effectiveness of Collaborative Care for Older Adults With Alzheimer Disease in Primary Care: A Randomized Controlled Trial. JAMA 2006; 295: 2148–2157
Vickrey BG, Mittman BS, Connor KI et al. The effect of a disease management intervention on quality and outcomes of dementia care — A randomized, controlled trial. Annals of Internal Medicine 2006; 145: 713–726
Dietz B. Die Pflegeversicherung — Ansprüche, Wirklichkeiten und Zukunft einer Sozialreform. München: Oldenburg Verlag, 2002
Ritter P, Hohmeier J. Alterspolitik. Eine sozio-ökonomische Perspektive. München: Oldenburg Verlag, 1999
Bartels S, Levine K, Shea D. Community-Based Long-Term Care for older Persons with severe and persistent Mental Illness in an Era of Managed Care. Psychiatric Services 1999; 50: 1189–1197
Williamson OE. Comparative Economic Organization: The Analysis of Discrete Structural Alternatives. Administrative Science Quarterly 1991; 36: 269–296
Langa K, Larson E, Wallace R et al. Out-of-Pocket Health Care Expenditures among older Americans with Dementia. Alzheimer Disease & Associated Disorders 2004; 18: 90–98
Skuban R. Pflegeversicherung in Europa. Sozialpolitik im Binnenmarkt. Wiesbaden: Verlag für Sozialwissenschaften, 2004
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zerth, J., Gaudig, M. & Schmid, A. Medikamentöse Versorgung von Demenzpatienten als Teil einer integrativen „Teamproduktion“ — Diskussion von Verschreibungs- und Behandlungsverhalten und gesundheitspolitische Handlungsempfehlungen. Pharmacoeconomics-Ger-Res-Articles 6, 53–68 (2008). https://doi.org/10.1007/BF03320751
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03320751