Bedarfsgerechtigkeit durch Verhaltensänderung?
摘要
An important component of medical care in line with demand is the prevention of overuse. Both internationally and in Germany, there are numerous examples of low-value care, i.e., measures that contribute neither to the health of the individual nor to the health status of entire patient or population groups in a meaningful way. These measures waste large shares of resources in healthcare and have harmful effects from a medical perspective for individuals as well as for the community. The driving forces behind overuse are diverse and lie both in systemic factors and in the personal behavior of doctors and patients. Since 2012, internationally with “Choosing Wisely,” and since 2015, in Germany with “Klug entscheiden,” initiatives have been in place aiming to effect behavioral change at a personal level. The tools are thematically well-focused recommendations that identify individual measures as low-value care, aiming to position doctors and patients at a critical distance from their application. The present article deals with the driving forces for medical overuse, describes the “Choosing Wisely” and “Klug entscheiden” campaigns, and attempts to estimate their potential effectiveness.