Improving access to prosthetic limbs in Germany: An explorative review.
Journal
Prosthetics and orthotics international
ISSN: 1746-1553
Titre abrégé: Prosthet Orthot Int
Pays: France
ID NLM: 7707720
Informations de publication
Date de publication:
01 Oct 2023
01 Oct 2023
Historique:
received:
09
06
2022
accepted:
09
06
2023
pubmed:
24
8
2023
medline:
24
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge. The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications. Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: "What were your experiences with the German prosthetic care and reimbursement system?" Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data. Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others. Equitable access to prostheses and the efficient distribution of prosthetic innovations could be improved by organizational and regulatory measures. Furthermore, a user-centered design of prostheses, a health technology assessment, monitoring of prosthetic care pathways, and a societal discussion about rationing in health care should be considered as parts of a broader approach to tackle this issue.
Sections du résumé
BACKGROUND
BACKGROUND
Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge.
OBJECTIVES
OBJECTIVE
The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications.
METHODS
METHODS
Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: "What were your experiences with the German prosthetic care and reimbursement system?" Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data.
RESULTS
RESULTS
Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others.
CONCLUSIONS
CONCLUSIONS
Equitable access to prostheses and the efficient distribution of prosthetic innovations could be improved by organizational and regulatory measures. Furthermore, a user-centered design of prostheses, a health technology assessment, monitoring of prosthetic care pathways, and a societal discussion about rationing in health care should be considered as parts of a broader approach to tackle this issue.
Identifiants
pubmed: 37615611
doi: 10.1097/PXR.0000000000000254
pii: 00006479-990000000-00155
pmc: PMC10561679
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
486-493Informations de copyright
Copyright © 2023 The Authors. Published by Wolters Kluwer Inc. on behalf of The International Society for Prosthetics and Orthotics.
Références
Egen C, Ranker A, Höpner K, et al. Versorgungskonzept zur Schliessung der rehabilitativen Lücke nach Majoramputation der unteren Extremität: Praxisbericht aus einem Innovationsfondsprojekt des Gemeinsamen Bundesausschusses [in German]. RP Reha 2020: 41–51.
Biddiss E, McKeever P, Lindsay S, et al. Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence. Prosthet Orthot Int 2011; 35: 215–224.
Baumann MF, Frank D, Kulla L-C, et al. Obstacles to prosthetic care—legal and ethical aspects of access to upper and lower limb prosthetics in Germany and the improvement of prosthetic care from a social perspective. Societies 2020; 10: 10.
Oberender P, Fleckenstein J. Auf sichere Beine stellen—Die Erstattung der Innovation C-Leg: Teil 1 [in German]. Orthop Tech 2005; 56: 154–161.
Herausgegeben Von Eurocom E.V. Recht Und Anspruch Bei Der Prothesenversorgung: Ein Ratgeber Für Patienten Und Fachhandel. 2016. https://eurocom-info.de/wp-content/uploads/2016/02/Final_Recht_und_Anspruch_bei_der_Prothesenversorgung1.pdf .
Mayring P, Fenzl T. Qualitative inhaltsanalyse. In: Baur N, Blasius J, eds. Handbuch Methoden der empirischen Sozialforschung. Wiesbaden: Springer Fachmedien Wiesbaden; 2014:543–556.
Bundesteilhabegesetz (BTHG). Gesetz Zur Stärkung Der Teilhabe Und Selbstbestimmung Von Menschen Mit Behinderungen. 2016. https://www.gesetze-im-internet.de/bthg/BJNR323400016.html.
Welti F. Hilfsmittel zum Behinderungsausgleich: Rechtlicher Rahmen und Reformbedarf1. Rehabilitation (Stuttg) 2010; 49(suppl 1): S37–S45.
Schröttle M, Anders P, Sarkissian H, et al. Country Report on Disability Assessment—Germany. 2019. https://www.disability-europe.net/country/germany .
Nierling L, Maia M. Assistive technologies: social barriers and socio-technical pathways. Societies 2020; 10: 41.
Fehres K, Urban T, Aleksic D, et al. Gemeinsame Stellungnahme vom Deutschen Olympischen Sportbund (DOSB), Deutschen Behindertensportverband (DBS), Deutschen Gehörlosensportverband (DGS) und Special Olympics Deutschland (SOD): zum Referentenentwurf des Bundesministeriums für Arbeit und Soziales. https://www.gemeinsam-einfach-machen.de/SharedDocs/Downloads/DE/AS/BTHG/Stellungnahme_DOSB.pdf?__blob=publicationFile&v=8
LSG München. Kostenübernahme für eine Sportprothese - unmittelbarer Behinderungsausgleich. file:///C:/Users/pj5164/Downloads/Y-300-Z-BECKRS-B-2019-N-20255.pdf
Schaffalitzky E, NiMhurchadha S, Gallagher P, et al. Identifying the values and preferences of prosthetic users: a case study series using the repertory grid technique. Prosthet Orthot Int 2009; 33: 157–166.
Kelley MA, Benz H, Engdahl S, et al. Identifying the benefits and risks of emerging integration methods for upper limb prosthetic devices in the United States: an environmental scan. Expert Rev Med Devices 2019; 16: 631–641.
Walker MJ, Goddard E, Stephens-Fripp B, et al. Towards including end-users in the design of prosthetic hands: ethical analysis of a survey of Australians with upper-limb difference. Sci Eng Ethics 2020; 26: 981–1007.
Jankowski N, Schönijahn L, Salchow C, et al. User-centred design as an important component of technological development. Curr Direct Biomed Eng 2017; 3: 69–73.
Wolff K, et al. Nutzerfreundliche, energieeffiziente, aktive Beinprothesen: Eine neue Entwicklungsmethodik bindet Prothesennutzer ganzheitlich ein. Orthop Tech 2014. https://www.prothetik.tu-darmstadt.de/forschungsprojekte_prothetik/nutzerfreundliche_aktive_beinprothesen/index.de.jsp
Mihoc A, Walters A, Eggbeer D, et al. Barriers to User-Centred Design in the Development of Bespoke Medical Devices: A Manufacturers' View. 13th Conference on Rapid Design, Prototyping & Manufacturing, Lancaster, UK; 2012. https://www.researchgate.net/publication/270579889_Barriers_to_User-Centred_Design_in_the_Development_of_Bespoke_Medical_Devices_A_Manufacturers%27_View .
Money AG, Barnett J, Kuljis J, et al. The role of the user within the medical device design and development process: medical device manufacturers' perspectives. BMC Med Inform Decis Mak 2011; 11: 15.
Kannenberg A, Seidinger S. Health economics in the field of prosthetics and orthotics: a global perspective. Can Prosthet Orthot J 2021; 4. doi: 10.33137/cpoj.v4i2.35298
doi: 10.33137/cpoj.v4i2.35298
World Health Organization & USAID. WHO standards for prosthetics and orthotics. World Health Organization; 2017. https://apps.who.int/iris/handle/10665/259209 .
Jones H, Dupan S, Coutinho M, et al. Co-creation facilitates translational research on upper limb prosthetics. Prosthesis 2021; 3: 110–118.
Tarricone R, Torbica A, Drummond M. Challenges in the assessment of medical devices: the MedtecHTA project. Health Econ 2017; 26(suppl 1): 5–12.
Cutti AG, Lettieri E, Verni G. Health technology assessment as theoretical framework to assess lower-limb prosthetics—issues and opportunities from an international perspective. J Prosthet Orthot 2019; 31: P55–P73.
van Twillert S, Geertzen J, Hemminga T, et al. Reconsidering evidence-based practice in prosthetic rehabilitation: a shared enterprise. Prosthet Orthot Int 2013; 37: 203–211.
Jones H, Webb L, Dyson M, et al. Towards user-centred prosthetics research beyond the laboratory. Front Neurosci 2022; 16: 863833.
Deutsche Vereinigung für Rehabilitation. Für eine optimierte Versorgung mit Hilfsmitteln. Eine Expertise der Deutschen Vereinigung für Rehabilitation zu aktuellen Problemen bei der Versorgung mit Hilfsmitteln. Rehabilitation (Stuttg) 2007; 46: 175–186.
Michaelis U. “Man müsste nur einen Ansprechpartner haben…” Wie major-beinamputierte Menschen ihre rehabilitative Versorgung erleben: Die Entwicklung einer gegenstandsbezogenen Theorie als Basis einer Optimierung der rehabilitativen Versorgung von Menschen vor, während und nach einer Majoramputation am Bein. Lübeck; https://d-nb.info/107088765X/34 . 2014.
Michaelis U, Gadys U. Optimierung Der Rehabilitativen Versorgung Von Menschen Vor, Während Und Nach Majoramputation: Abschlussbericht. Hamburg: Hochschule für Angewandte Wissenschaften, Department Pflege und Management; 2012. https://reha-vffr.de/images/vffrpdf/projekte/2012/Bericht_final_2012_12_21.pdf .
FST. Beinprothesen-Register in Heidelberg soll Versorgungsqualität erheben. Ärzte Zeitung 2022. https://www.aerztezeitung.de/Nachrichten/Beinprothesen-Register-in-Heidelberg-soll-Versorgungsqualitaet-erheben-429058.html .
Swiss- TA. Nutzen und Kosten medizinischer Behandlungen zwischen individuellen und kollektiven Interessen; 2012. https://www.samw.ch/de/Projekte/Uebersicht-der-Projekte/Kosten-Nutzen-Analysen.html.
Soares MO. Is the QALY blind, deaf and dumb to equity? NICE's considerations over equity. Br Med Bull 2012; 101: 17–31.
Olsen JA, Smith DR. Theory versus practice: a review of “willingnessto‐pay” in health and health care. Health Econ 2001; 39–52.
King JT, Tsevat J, Lave JR, et al. Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation. Med Decis Making 2005; 25: 667–677.
Rogowski WH, Grosse SD, Schmidtke J, et al. Criteria for fairly allocating scarce health-care resources to genetic tests: which matter most? Eur J Hum Genet 2014; 22: 25–31.