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Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum Bad Abbach

Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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Page 1: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 2: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die
Page 3: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Private praxis

Page 4: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Facts about Germany

Area 357.092,90 km²

Population 83 Million

Population density 230 per km²

Page 5: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Health Care in Germany• Largest employment sector in Germany

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

Page 6: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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)

Page 7: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• 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

Page 8: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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 %

Page 9: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• 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

Page 10: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• 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

Page 11: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 12: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 13: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Costs for health service per year - men

Page 14: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Costs for health service per year - women

Page 15: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Increase of costs for health service from 1995 to 2004

Page 16: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Quelle: Statistisches Bundesamt (2006 a)

Population of Germany 2000 and 2050

Page 17: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 18: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Statistics of physicians

Physicians altogether 407.000

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

Page 19: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

BVOUca. 6950 MembersOrthopaedic Surgeons, mostly in private praxis

Page 20: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

30

35

40

45

50

55

1993 1995 1997 1999 2001 2003 2005

Private praxis

Hospital

Average age of physicians

Page 21: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 22: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

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

Page 23: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Certified surgeons

2004 2005 2006

Male 731 657 589

Female 215 214 201

Total 946 871 790

Page 24: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

German Orthopaedic Association

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

Association and German Trauma Association in 2008

• Annual congress in Berlin

Page 25: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• 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

Page 26: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• 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*

Page 27: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

• individual and age-based health promotion

• enhancing attractiveness of medical profession

• investive social policy: prevention before rehab

Objectives

Page 28: Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die

Thank you for your attention