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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