Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German...

Orthopaedics and Traumatology in Germany

Prof. Dr. med. Joachim GrifkaPresident of the German Orthopaedic Association 2008

Orthopädische Klinik für die Universität Regensburgim Asklepios Klinikum Bad Abbach

Private praxis

Facts about Germany

Area 357.092,90 km²

Population 83 Million

Population density 230 per km²

Health Care in Germany• Largest employment sector in Germany

(over 4 Million jobs)• 2.104 hospitals• Appr. 1000 rehabilitation departments

Costs of public health care

• Multiple public insurance organizations linked by a common legal framework

• 11,1 % of GDP is spent on health (2,5 % more than the average OECD member countries)

• Currently over 30 million people are suffering from MSD*

• Increasing of MSD* as main diagnosis between 1994 and 2005 up to 37,1 % (MSD* cases 1994: 1.021.265 2005: 1.400.649)

• Back pain is the second most common diagnosis;three-month prevalence children/ youth 32,9%

• 2005: 367.593 people with arthrosis for admission *musculoskeletal diseases

Number of cases

Costs of public health care

Total expediture / year € 234 bil

- Thereof women / year € 3.160 per head

- Thereof men / year € 2.240 per head

- Thereof hospitalexpences / year 34,0 %

• direct health care costs (2002)

degenerative: 25,2 bil € traumatical 10,6 bil €

→ about 16 % of total health care costs

→ more than 1,7 % of the German GDP

Expenses for MSD

• leading cause for work disablement (wd)

degenerative traumatical

18 % 9 % of all wd cases

27 % 13 % of all wd days

→ loss of production more than 100 bil €

→ according to 4,8 % of German GDP

• 25 % of all early retirements

Number of musculoskeletal diseases Germany

Endoprotheses in Germany acc. FBMTI

joint type Units in 2007

knee uni-condyle 9.000bi- condyle 134.000revision 12.000

hip prim 180.000short diaphysis 9.400revision 7.500surface replacem. 4.000

ankle 1.520shoulder 9.250

Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

Effect of age opposite health care costs

Actual survival curve age-group over 60 years

Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

Costs for health service per year - men

Source: Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

Costs for health service per year - women

Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

Increase of costs for health service from 1995 to 2004

Quelle: Statistisches Bundesamt (2006 a)

Population of Germany 2000 and 2050

Beske, F. u.a.: Gesundheitsversorgung 2050, Kiel 2007

Demographical change 2000 - 2050Classification 2000 2010 2020 2030 2040 2050 Changes 2000

until 2050 in %

Population / Mill. 82,3 81,9 80,1 77,2 73,4 68,8 - 16,4

Population 65 and older / Mill. 13,7 16,8 18,6 22,1 23,5 22,9 + 67,2

Population 80 and older / Mill. 3,1 4,3 5,9 6,3 7,9 10,0 + 222,6

Population employable age (20 to 65) / Mill. 51,2 50,0 48,0 42,4 38,4 35,5 -30,7

Statistics of physicians

Physicians altogether 407.000

- Thereof outpatient section 136.000- Thereof inpatient section 148.300- Thereof orthopeadic specialists 8906

BVOUca. 6950 MembersOrthopaedic Surgeons, mostly in private praxis

30

35

40

45

50

55

1993 1995 1997 1999 2001 2003 2005

Private praxis

Hospital

Average age of physicians

0

5

10

15

20

25

30

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

%

Physicians under the age of 35

70.000

75.000

80.000

85.000

90.000

95.000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Students human medicine

Certified surgeons

2004 2005 2006

Male 731 657 589

Female 215 214 201

Total 946 871 790

German Orthopaedic Association

• Founded in 1901• 2448 members• Amalgamation of German Orthopaedic

Association and German Trauma Association in 2008

• Annual congress in Berlin

• so far 2,8 % of annual research funding by BMBF*¹ and DFG*² for musculoskeletal science

• 360.000 € by DGOOC*³ for determined sponsorship regenerative and biomechanical projects in research network• expectations to Road Map-Agenda by BMBF*¹

*¹ Federal Ministry of Education and Research

*² German Research Foundation

*³ German Orthopaedic Association

Research funding

• Incidence und prevalence MSD* conditioned to age and sex

• Training situation and qualification• Orthopaedic surgeon is the „General practitioner“ for bones and joints

*musculoskeletal diseases

Treatment options MSD*

• individual and age-based health promotion

• enhancing attractiveness of medical profession

• investive social policy: prevention before rehab

Objectives

Thank you for your attention