Tailormade Worksite Health Promotion on its Practical Realization by Health Insurances and Companies
©2006
Masterarbeit
89 Seiten
Zusammenfassung
Inhaltsangabe:Abstract:
A healthy economy requires healthy enterprises. In turn, an enterprise stands and falls with the health, i.e. efficiency and commitment of its most important creation of value factor, the employee.
Directly visible or also invisible time missed by temporary losses or chronic duration illnesses, high fluctuation, poor motivation, poor creativity and service quality, missing emotional tie with the enterprise or inner notice weaken not only the competition ability and the stock of an enterprise, but charge the national economy and the health system altogether.
According to model calculations by the Federal Institute of Maintenance of Industrial Health and Safety Standards from the year 1998, enterprises in Germany spend about 28.4 billion euros per annum for employees fallen ill directly. The damage by a direct illness conditional production loss is estimated at about 45 billion euros per annum.
The complete economic damage among others due to high time missed, low motivation, productivity, etc. amount to a valued sum for the federal territory between 234 and 245 billion euros per annum.
Tailormade interventions to the worksite health promotion support companies to maintain and to promote the health, i.e. efficiency and performance readiness of their employees, to lower direct and indirect time missed and therefore illness costs. Among others, Heuchert et al. point at a prevention potential not exhausted until now.
The health insurance companies can carry out measures of the operational health support completing the maintenance of industrial health and safety standards. So the legal order of the health insurance companies in the context of the Code of Social Law to take up and to realize interventions, which contains a high potential for enterprises.
In accordance with a study of the federal ministry for health and social affairs (BMGS), about 45% of the legally scheduled budget was used for health support by health insurance companies in the year 2002. The judging size provided by the year 2002 amounted to Euro 2.56 per annum, Euro 1.19 per insured was spent in the year 2002, according to the study. Current data from the year 2005 were not published yet.
The operational health support has developed further within the last three years. However, it is assumed that the health potential lying in § 20 SGB V is neither exhausted by health insurance companies nor enterprises on a full scale yet.
The topic seems rather […]
A healthy economy requires healthy enterprises. In turn, an enterprise stands and falls with the health, i.e. efficiency and commitment of its most important creation of value factor, the employee.
Directly visible or also invisible time missed by temporary losses or chronic duration illnesses, high fluctuation, poor motivation, poor creativity and service quality, missing emotional tie with the enterprise or inner notice weaken not only the competition ability and the stock of an enterprise, but charge the national economy and the health system altogether.
According to model calculations by the Federal Institute of Maintenance of Industrial Health and Safety Standards from the year 1998, enterprises in Germany spend about 28.4 billion euros per annum for employees fallen ill directly. The damage by a direct illness conditional production loss is estimated at about 45 billion euros per annum.
The complete economic damage among others due to high time missed, low motivation, productivity, etc. amount to a valued sum for the federal territory between 234 and 245 billion euros per annum.
Tailormade interventions to the worksite health promotion support companies to maintain and to promote the health, i.e. efficiency and performance readiness of their employees, to lower direct and indirect time missed and therefore illness costs. Among others, Heuchert et al. point at a prevention potential not exhausted until now.
The health insurance companies can carry out measures of the operational health support completing the maintenance of industrial health and safety standards. So the legal order of the health insurance companies in the context of the Code of Social Law to take up and to realize interventions, which contains a high potential for enterprises.
In accordance with a study of the federal ministry for health and social affairs (BMGS), about 45% of the legally scheduled budget was used for health support by health insurance companies in the year 2002. The judging size provided by the year 2002 amounted to Euro 2.56 per annum, Euro 1.19 per insured was spent in the year 2002, according to the study. Current data from the year 2005 were not published yet.
The operational health support has developed further within the last three years. However, it is assumed that the health potential lying in § 20 SGB V is neither exhausted by health insurance companies nor enterprises on a full scale yet.
The topic seems rather […]
Leseprobe
Inhaltsverzeichnis
1
Contents List
Contents List
1
Illustration List
4
Table List
4
Introduction
5
Theoretical Background
1.
Bases of the Worksite Health Promotion
8
1.1
Importance of the Worksite Health Promotion
8
1.2
Changes in Working Conditions
9
1.3
Business Economic Aspect
9
1.4
People and World Economic Aspect
11
2.
Legal Framework of the Worksite Health Promotion
12
2.1
Prevention Oriented Regulations in the § 20 SGB V
13
2.2
Prevention as a Legal Order and Task of Health Insurances
13
2.3
Development of the § 20 SGB V in the Course of Time
14
2.3.1
Health Support according to the Health Reform Law 1989-1996
14
2.3.2
Restrictions by the Contribution Relief Law 1997-1999
14
2.3.3
Modified new Beginning as of 2000 by the "GKV Health Reform"
15
2.4
Free Choice of Health Insurance Companies
15
2.5
Common Action Fields of Health Insurance Companies
16
2.6
Previous Realization of the § 20 SGB V
17
3.
Specification of the Question
18
Empirical Part
4.
Examination Methods
19
4.1
Examination Relevance
19
4.2
Examination Instrument
20
4.3
Examination Material
21
4.3.1
Construction of the Interview Guide
21
4.3.2
Aims of the concrete Questions of the Interview Guide
22
4.3.2.1 Corresponding Questions for Health Insurances and Companies
22
4.3.2.2 Questions differing from it for Companies
25
2
4.4
Selection of the Examination Collective
26
4.5
Planning of the Examination
26
4.6
Execution of the Examination
26
4.7
Refurbishing, Analysis and Representation of the Data
28
5.
Representation of the Results
29
5.1
Health Insurances
29
5.1.1
Competences
29
5.1.2
Importance of the Worksite Health Promotion
31
5.1.3
Development of the Worksite Health Promotion since 2000
33
5.1.4
Cooperation
34
5.1.5
Possibilities for Companies
36
5.1.6
Practical Realization of the Worksite Health Promotion
38
5.1.7
Inconvenient Factors from View of Health Insurances
40
5.1.8
Beneficial Factors from View of Health Insurances
43
5.1.9
Need for the Future from View of Health Insurances
46
5.2
Companies
47
5.2.1
Competences
47
5.2.2
Importance of the Worksite Health Promotion
48
5.2.3
Development of the Worksite Health Promotion since 2000
49
5.2.4
Cooperation
50
5.2.5
Information on the Possibilities for Companies
51
5.2.6
Practical Realization of the Worksite Health Promotion
52
5.2.7
Inconvenient Factors from View of Companies
54
5.2.8
Beneficial Factors from View of Companies
56
5.2.9
Need for the Future from View of Companies
58
Concluding Part
6.
Discussion
59
6.1
Interpretation of the Results
59
6.1.1
Importance of the Worksite Health Promotion
59
6.1.2
Development of the Worksite Health Promotion since 2000
61
6.1.3
Cooperation
62
6.1.4
Possibilities of the § 20 SGB V
63
6.1.5
Information on the Possibilities of the § 20 SGB V
64
6.1.6
Practical Realization of the Worksite Health Promotion
64
6.1.7
Beneficial Factors for Worksite Health Promotion
65
3
6.1.8
Need for the Future
67
6.2
Action Recommendations for the Practice
67
6.2.1
Competences
67
6.2.2
Importance of the Worksite Health Promotion
67
6.2.3
Concep
t and Definition of the Worksite Health Promotion
68
6.2.4
Management
68
6.2.5
Resources
68
6.2.6
Development of the Worksite Health Promotion
68
6.2.7
Cooperation
68
6.2.8
Legal Framework Conditions
69
6.2.9
Practical Realization of the Worksite Health Promotion
70
6.2.10 Need for the Future
70
6.3
Incorporation into the current Research Context
71
6.4
Further Examination Recommendations
71
6.5
Complete Assessment
71
6.6
View
71
7.
Summary
72
8.
Literature List
74
9.
Affidavit
77
10.
Appendix List
78
Appendix
4
Illustration List
Illus. 1 Factors involved in Worksite Health Promotion
66
Table List
Tab. 1
Benefit of the Worksite Health Promotion
11
Tab. 2
Core Motivations for WHP from View of Health Insurances
31
Tab. 3
Possibilities to realize WHP
36
Tab. 4
Inconvenient Factors from View of Health Insurances
41
Tab. 5
Beneficial Factors from View of Health Insurances
43
Tab. 6
Need for new Concepts from View of Health Insurances
46
Tab. 7
Core Motivations for WHP from View of Health Insurances
48
Tab. 8
Measures realized by Companies within the Action Fields
of Health Insurances
49
Tab. 9
Measures realized by Companies outside the Action Fields
of Health Insurances
50
Tab. 10
Offers of Health Insurances for Companies
(from Company View)
52
Tab. 11
Inconvenient Factors from View of Companies
54
Tab. 12
Beneficial Factors from View of Companies
56
Tab. 13
Need for new Concepts from View of Companies
58
5
Introduction
A healthy economy requires healthy enterprises. In turn, an enterprise stands and falls
with the health, i.e. efficiency and commitment of its most important creation of value
factor, the employee.
Directly visible or also invisible losses of productive working time by temporal sick-
leaves or chronic duration illnesses, high fluctuation, poor motivation, poor creativity
and service quality, missing emotional tie with the enterprise or inner notice weaken not
only the competition ability and the stock of an enterprise, but charge the national
economy and the health system altogether.
According to model calculations by the Federal Institute of Maintenance of Industrial
Health and Safety Standards from the year 1998, enterprises in Germany spend about
28.4 billion euros per annum for employees fallen ill directly (Friedel et al., 2002, p. 34
pp.). The damage by a direct illness conditional production loss is estimated at about
45 billion euros per annum (Kuhn, 1996, p. 131 pp.).
The complete economic damage among others due to high losses of productive
working time, low motivation, etc. amount to a valued sum for the federal territory
between 234 and 245 billion euros per annum (Gallup, 2004).
Tailormade interventions to the worksite health promotion support companies to
maintain and to promote the health, i.e. efficiency and performance readiness of their
employees, to lower direct and indirect losses of productive working time and therefore
illness costs (cf. among others Badura, 1999, Bamberg et al., 1998). Among others,
Heuchert et al. (1996) point at a prevention potential not exhausted until now.
"The health insurance company shall provide performances in the statute to the
primary prevention (§ 20, SGB V para. 1). The health insurance companies can carry
out measures of the operational health support completing the maintenance of
industrial health and safety standards " (§ 20, SGB V para. 2).
So the legal order of the health insurance companies in the context of the Code of
Social Law to take up and to realize interventions, which contains a high potential for
enterprises.
In accordance with a study of the federal ministry for health and social affairs (BMGS),
about 45% of the legally scheduled budget was used for health support by health
6
insurance companies in the year 2002. The judging size provided by the year 2002
amounted to 2.56 per annum, 1.19 per insured was spent in the year 2002 (BMGS,
2003), according to the study. Current data from the year 2005 were not published yet.
The operational health support has developed further within the last three years.
However, it is assumed that the health potential lying in § 20 SGB V is neither
exhausted by health insurance companies nor enterprises on a full scale yet.
,,The topic seems rather unimportant at first sight...it is worthwhile on the second look
despite this comparatively small size of the expenditure to watch and to form the topic
"prevention by health insurance companies" with special attention. Why? This is
worthwhile because although the first and right step is very very timid, it is just done to
one SGB V in that direction in which success or failure of a future "health" politics which
earns this name will make up its mind. The way of 1,000 miles starts with a first step"
(Rosenbrock, 2001).
Aim of the master thesis on hand therefore is to receive an insight into the current
realization and previous development of the operational health support in the context of
a site regulation and for the practical realization, to find out beneficial as well as
inconvenient factors. The prospects shall be included and compared comparatively
both by enterprises and by health insurances. A broader aim of the study is taken up to
find out to which extent the possibilities of the operational health support are known to
the enterprises and whether the currently available prevention offers show the actual
need currently as well as for the future.
From this, concrete action recommendations for further positive development of the
operational health support shall be derived in the future.
Since this study is a practice oriented empirical work, theoretical background is outlined
only briefly. In the theoretical part, the prevention oriented regulations and possibilities
of the operational health support in the § 20 SGB V are represented briefly before the
contents of SGB V will be presented.
7
For the current realization, the questions which shall be examined in the empirical part
following on this are derived from the data on hand.
To this, methodology and execution of data collection and analysis are explained at
first. The results of the interview are introduced and discussed in this connection.
Concrete action recommendations for the further positive development and practcal
realization of the operational health support are derived from it for the future.
The concepts "operational health support" and "worksite health promotion" are used
synonymously and abbreviated repeatedly with "WHP" in the following.
8
Theoretical Background
1.
Bases of the Worksite Health Promotion
Health support according to the Ottawa charter of the world health organisation is
,,...aimed to a process to enable all people to a higher degree of self-determination and
thus to strengthen their health." (Ottawa charter of the world health organisation, 1986).
"Worksite health promotion (whp) covers all common measures of employers,
employees and society for the improvement in health and well-being at work. This can
be reached ba combination of the following approaches: Improvement in work
organisation and working conditions, support of an active employee participation,
strengthening of personal competences" (Luxembourg declaration, 1997).
1.1
Importance of the Worksite Health Promotion
Since a variety of epidemiological and work psychological studies has proved the
significance of work for our health (cf. e.g. Greif et al, 1991, Rosenbrock, 1993), special
attention has to be assigned to the worksite health promotion.
To be able to put it into action, principles can be derived which are to be understood as
action leading normative objectives and which can be summarized as follows:
·
"Inclusion of the psychosocial aspects of health,
·
Identification and design of the features of work which increase the well-being
and action ability of the employees,
·
Inclusion of interventions to change behaviour and situations or relationships,
·
Broad target group
·
Long-term orientation and sustainability of the concept
·
Direct and indirect participation in the complete process of health promotion"
(Bamberg et al, 1998, p. 21)
1.2
Changes in Working Conditions
The working world changes by the dynamic transition of the industry to the service and
information company: new markets, lines of business as well as work and organisation
forms come into being which are connected to the charges and requirements on the
9
working person with strong changes (Wieland, 2000). The share of production oriented
risks, such as risky physical or chemical conditions, decreases, while the increasing
service and information sector enhances primarily emotional, mental and social
workloads (cf. among others Badura, 1999, Bamberg et al, 1998, Kaluza, 2004).
Health damaging charges arise, e.g. triggered by "an emotional dissonance" at
represention of emotions not felt or by oppression of emotions felt, which is required
primarily in nursing, social or business looking professions (Semmer et al, 2001),
followed by inadequate coping strategies, such as excessive consumption of semi-
luxury items (e.g. alcohol, nicotine or illegal drugs), social conflicts and physical risks
by lack of exercise or excess weight.
Changes in company structures, indicated by customer orientation, flat hierarchies,
scarce personnel resources, amplified use of information and communication
technologies, increasing information and work density etc, require flexible, creative,
highly educated and motivated employees.
Requirements on the employees increase to the extent of the increase of requirements
on the enterprises in the context of economic cost-push and competitive pressure.
To be able to encounter these requirements durably, the health, i.e. the efficiency and
performance readiness of the employees gets more and more important (cf. among
others Bamberg et al, 1998, Kaluza, 2004).
1.3
Business Economic Aspect
Directly visible or also invisible losses of productive working time by temporary sick-
leaves or chronic duration illnesses, high fluctuation, poor motivation, poor creativity
and service quality, missing emotional tie with the enterprise or inner notice weaken the
competition ability and the stock of an enterprise of the market.
According to model calculations of the Federal Institute of maintenance of industrial
health and safety standards from the year 1998, costs used by enterprises for work
conditional illnesses are assumed to amount to about 28.4 billion euros per annum in
Germany alone.
Work conditional illnesses are health disturbances which are caused by work
circumstances completely or partly. Furthermore, it is distinguished between physical
10
and emotional strains. The sum consists of 14.9 billion euros direct costs for the illness
treatment and 13.5 billion euros indirect costs. The loss of acquisition years is part of
the indirect costs by work inability. Emotional workloads caused 11.1 billion euros
direct costs and 13.4 billion indirect costs, together that is 24.5 billion total costs. The
costs for illnesses due to physical and emotional strains may not be added up since an
illness can be caused by physical and emotional workloads at the same time. With
about 9.5 billion euros muscle and skeleton diseases cause about one third of all work
conditional illness costs.
The contribution of work conditional emotional charges of these economically
meaningful illnesses is very high. Under prevention points of view it is to be considered
that single charging factors cannot be banished from the working world completely. But
already by the reduction of the greatest emotional charges, approximately every sixth
work inability could be prevented by these illnesses. Through this, 1.8 billion euros
direct costs and 2.0 billion euros indirect costs could be saved.
The introduced numbers might rather fall below the actual work conditional costs in
Germany. Merely a choice of charging factors and illnesses could be examied.
Furthermore, only temporary illnesses were taken into account. The presented
numbers underline the urgency and the potential of prevention measures and
programmes in the working world (Friedel et al, 1998, p. 34 pp.). Among others,
Heuchert et al. point at a prevention potential not exhausted until now (1996, p. 458
pp.)
Until now, it is not possible to furnish an adequate quantiative proof of the use of the
worksite health promotion in a satisfactory extent in view of the complexity of the
interactions of all fctors involved.
While a "loss by illness" is easily quantifiable, a "profit by health" usually gets
transparent only in costs saved hypothetically. So examinations have shown with
DuPont, that any dollar invested in worksite health promotion is rewarded by a reduced
number of sick persons with a profit of 1.42 dollars (Hendrix et al, 1995, p. 73 pp.). It
can not be assessed, however, to which extent these data can be transferred to
German conditions.
11
"The immaterial profit of health which finds its expression in a high identification with
the enterprise and a high work motivation of the employees does not find any
immediately measurable business economic result" (Bamberg et al, 1998, p. 25).
Despite all methodological difficulty in quantifying the business economic use of the
worksite health promotion adequately, the advantages pass a comprehensible
understanding among the users, which can be summarized in accordance with Tab. 1
as follows:
Tab. 1: Benefit of WHP (www.sozialnetz-hessen.de/ergo-online/Vorsorge/BetrieblicheGesundheitsfoer-
derung.htm of 13.02.2005.)
Benefit for the Enterprise
Benefit for the Employee
Benefit
for
the
Social
Systems
Increased work satisfaction and
work prouctivity.
Less workloads
Lower claims on medical and
rehabilitative performances
Long-term reduction in the number
of sick persons
Reduced physical complaint Longer professional life
Increased production and service
quality
Increased well-being
Safeguarding
of
the
contributions in legal health
insurance companies
Improved
operational
communication and cooperation
Positive
atmosphere
of
work
Image upgrading for the enterprise More willingness to work
Decreasing fluctuation
Healthier
behaviour
in
business and leisure time
Mutual support
High self-esteem
1.4
People and World Economic Aspect
The people and world economic aspect also has to be taken into account besides the
business economic one because directly visible or also invisible losses of productive
working time altogether load the German national economy and the health system as
well as the world economy.
So the damage is estimated at about 45 billion euros per annum nationwide (Kuhn,
1996, p. 131 pp.) by a direct illness conditional production loss. According to the Gallup
study from the year 2004, the complete economic damage among others due to high
losses of productivity, low motivation, etc. for the German federal territory amounts to a
valued sum between 234 and 245 billion euros per annum (Gallup, 2004). Comparable
estimates for the worldwide damage cannot be taken from the current literature
research.
12
In comparison to this, the nationwide expenses of the legal health insurance
companies take only little interest for prevention with about 148 million euros in the
year 2004 (documentation of the central associations of the health insurance
companies, 2004, p. 13 pp.)
The height of the economies obtainable by health support is valued at 20 to 20 per cent
of all work inabilities. However, it is completely unknown which prevention charges
would have to be concluded to actually prevent nationwide productivity losses.
Methodical instruments required for a specific efficiency measuring are only available in
essential features today (Thiefhoff, 1995, p. 58 pp.).
2.
Legal Framework of the Worksite Health Promotion
Various legal regulations and guidelines which mark the legal frame out for the
realization of the worksite health promotion consist in the Federal Republic of
Germany. In an abriged version are named here
·
The business constitution law of 1972, changed last on 21.09.2005
·
The law over company physicians, safety engineers and other qualified
employees of the work safety (AsiG) of 1973, changed last on 25.11.2003
·
The law for the realization of the EC framework directive maintenance of
industrial health and safety standards and further maintenance of industrial
health and safety standards guidelines of 07.08.1996, there article 1, "law on
the execution of measures of the maintenance of industrial health and safety
standards for the improvement in the safety and the health protection of the
employees at work" (ArbSchG), changed last on 30.07.2004
·
The regulations to this enlarged prevention order of the legal accident insurance
in the renewed SGB VII (in the setting of the law to save the lasting financing
bases of the legal pension insurance (sustainability law) of 21.07.2004) (BGBL I
p. 1791)
·
As well as the regulations in the § 20, 54 and 63 of the Code of Social Law V in
the amendment of 2000 (in the setting of the law to save the lasting financing
bases of the legal pension insurance (sustainability law of 21.07.2004) (BGBL I
p. 1791)
13
Due to the meaningful potential for enterprises to turn over tailor-made, i.e. integrally
oriented and individual interventions of the worksite health promotion tailored to the
enterprise with technical and financial support of the health insurance companies, § 20
SGB V is stressed in the following.
2.1
Prevention Oriented Regulations in the § 20 SGB V
Performances to the health support were legally established in the area of health
insurance companies only at the end of the eighties, i.e. two years after adoption of the
Ottawa charter and after voluntary several years of primary preventative activities (cf.
Schwartz et al, 1998).
2.2
Prevention as a Legal Order and Task of the Health Insurance Companies
§ 20 SGB V is of central importance for the primary prevention as well as for the
operational health support.
It has to be said that the wording of the § 20 SGB V does not distinguish between the
rather illness oriented approach of ,,prevention" and the resource oriented approach of
,,health support". The two concepts are therefore used synonymously in the following
explanations.
"(1) The health insurance company shall provide performances in the statute to the primary
prevention which fulfill the requirements mentioned in the sets of 2 and 3. Performances to the
primary prevention shall improve the general health condition and produce particularly a
contribution to the reduction of socially conditional inequality of health chances. The central
associations of the health insurance companies decide together and uniformly on prioritary
action fields and criteria for performances under inclusion of independent expertise after lap 1
particularly with regard to need, target groups, access ways, contents and methodology.
(2) The health insurance companies can carry out measures of the operational health support
completing the maintenance of industrial health and safety standards; Paragraph 1 set 3 is
correspondingly valid. The health insurance companies work for the contraception of work
conditional health dangers together with the straps of the legal accident insurances and inform
them about their knowledge they have won about connections between illnesses and working
conditions. If it has to be assumed that with an insured there is endangering an occupational
disease, the health insurance company has to inform the jobs responsible for the maintenance
of industrial health and safety standards and the accident insurance strap about it immediately.
(3) Altogether, the expenses of the health insurance company for the perception of her tasks
after the paragraphs 1 and 2 shall cover an amount of 2.52 euros for each of her insured in the
year 2000; they are to be adopted according to the proportional change of the monthly
reference quantity according to § 18 SGB IV set 1 in the subsequent years" (§ 20 SGB V para.
1 to 3, 2000).
14
So the legal order of health insurance companies in the context of the Code of Social
Law, § 20 SGB V.
This legal order of the health insurance companies includes at the same time a high
potential for enterprises to take up and to turn over tailor-made interventions to the
operational health support technically and financially by health insurance companies.
2.3
Development of the § 20 SGB V in the Course of Time
Due to its central importance, the development of the § 20 SGB V and its legal
changes within the last few years are briefly outlined in the following.
2.3.1 Health Support according to the Health Reform Law 1989-1996
With the health reform law (GRG) of 1988, measures for the health support received for
the first time a legal move by the introduction of the § 20 into the health system. At the
same time, health insurance companies could become even performance inheriting
wrestlers with that. The very open wordings in the wording of the § 20 SGB V revealed
a very wide field of activity to them. Individual consultations and group offers were in
the foreground of the health insurcance-related activities primarily in the areas of diet,
movement and stress management. Furthermore, single health insurcance types
committed themselves in the worksite health promotion, which could be decided on by
the statutes of the individual health insurcances voluntarily as a design performance
could (Schwartz et al, 1998).
2.3.2 Restrictions by the Contribution Relief Law 1997-1999
Seven years after the introduction, i.e. 1996, the health support was taken out of the
obligation catalogue of the health insurcances again in the legal sick person insurance
in the context of the contribution relief law. Mentioned reasons therefore were among
others the health insurcance competition established newly by the health structure law
of 1993, as well as the increasing marketing oriented offers for WHP by health
insurances which was marked colloquially also as a "belly-dance discussion".
Substantial economies of the federation were a deeper reason for the cut of the health
support in the area of the job package in favour of the pensions and unemployed
insurance as well as the care insurance.
15
With the abolition of the health support 1997, numerous employees were dismissed or
taken in other health insurcance specific divisions. While private health insurances
were reducing the preventative structures almost completely, others, primarily health
insurcances with an operational orientation, tried to hold a part of her employees.
Altogether, this development led to a considerable loss of structures and competence
which had difficulty to be rebuilt after reintroduction of the primary prevention (Schwartz
et al, 1998).
2.3.3 Modified New Beginning as of 2000 by the GKV Health Reform
The GKV health reform law to become effective on 01.01.2000 assigns a task to the
health insurance companies with the primary prevention as a debit performance with a
character obliging strongly. The new version of the § 20 "prevention and self-help" tries
to pick up at target groups, methods and access ways: Lack of clear physical aims,
lack of group orientation and too much "middle shift orientation" into marketing,
methods and realization with the result of prior-ranking demands by the health-
conscious insured in the practice. With the mentioning of explicit request criteria,
concepts shall as a matter of priority be counteracted at the same time from marketing
aspects.
The health insurances can now again carry out measures of the worksite health
promotion like already carried out in the years from 1989-1996. To these, the same
requirements as to the primary prevention are made. For the two areas, the legislator
provides a reference value of 2.52 euros per insured in the year 2000. In the year
2005, the judging size amounts to 2.70 euros per insured (cf. § 20 SGB V). The central
associations of the health insurance companies have to be worked out in the areas of
the primary prevention and the worksite health promotion, particularly with regard to
need, target groups, access ways, after the new version of the § 20 SGB V invited
common and uniform action fields and criteria for the realization, contents and
methodology. It is tried with the obligation of the health insurcances to the common
development of action recommendations as well as the explicit mentioning of quality
securing criteria to soothe the influence of the competition.
2.4
Free Choice of the Health Insurance Companies
Since 01.01.1996, employees can choose the health insurance company freely.
16
On this day, the new health structure law became effective. About 300 different health
insurance companies are listed at present. These can be assigned to four different
health insurcance types (cf. www.krankenkassentarife.de):
1.
General compulsory medical assurance schemes (AOK)
2.
Substitute health insurance companies (EK)
3.
Business health insurance companies (BKK)
4.
Guild health insurance companies (IKK)
2.5
Common Action Fields of the Health Insurance Companies
According to the Code of Social Law § 20 SGB V, the health insurance companies
carry out measures of the worksite health promotion completing the maintenance of
industrial health and safety standards and work together with the accident insurance for
the contraception of work conditional health dangers. The central associations of the
health insurance companies have agreed on prioritary action fields in a common action
guide in the worksite health promotion in the year 2000.
These cover the areas:
·
Work conditional physical strains
·
Nutrition/Business catering
·
Psychosocial stress
·
Pleasure and addictive drug consumption.
Health insurances therefore support enterprises and authorities through:
·
Determination of the risk factors and the health potentials of the employees
under use of the work inability analyses, endangering judgements, inclusion of
the company doctors, interview of the employees
·
Health circles
·
Development of a concept for behaviour- and relationship-related worksite
health promotion, common with the business and if necessary with the accident
insurance. These measures get alone, if necessary common with the accident
insurance or carried out by engaged, suitable service providers of the health
insurance company.
17
(Cf. action guide of the central associations of the health insurance companies for the
realization of § 20, para. 1 and 2, SGB Vof 21.06.2000 in the setting of 12.09.2003, p.
30).
2.6
Previous Realization of the § 20 SGB V
In accordance with a study of the federal ministry for health and social affairs (BMGS),
about 45% of the legally scheduled budget were used for health support by health
insurance companies in the year 2002. The judging size provided by the year 2002
amounted to 2.56 euros per annum per insured. 1.19 euros per insured were actually
spent in the year 2002 (BMGS 2003). Until now, current data from the year 2005 were
not published yet.
,,The topic seems rather unimportant at first sight...it is worthwhile on the second look
despite this comparatively small size of the expenditure to watch and to form the topic
"prevention by health insurance companies" with special attention. Why? This is
wothwhile because although the first and right step is very very timid, it is just done to
one SGB V in that direction in which success or failure of a future "health" politics which
earns this name will make up its mind. The way of 1,000 miles starts with a first step"
(Rosenbrock, 2001).
18
3.
Specification of the Question
The operational health support has developed further within the last three years. It is
assumed, however, that currently the health potential lying in the § 20 SGB V is neither
exhausted by enterprises nor by health insurances on a full scale yet.
The concrete questions of this examination therefore are:
1.
How do meaning and importance of the worksite health promotion have to be
assessed in practice currently?
2.
What are the motivating reasons for health insurances and companies to
engage in worksite health promotion?
3.
How does the cooperation of the protagonists involved have to be assessed?
4.
At present, which possibilities of the health insurcance initiated WHP are
existing and how known are these possibilities to companies?
5.
To what extent are the possibilities lying in § 20 SGB V exhausted currently,
i.e. in the year 2005?
6.
How are these possibilities realized in practice?
7.
What are the beneficial and inconvenient factors perceived by health
insurances and enterprises?
8.
Do the already existing offers show the need actually perceived?
9.
Which action fields gain meaning from view of the experts for the future?
10.
Altogether, which concrete action recommendations for further positive
development of the WHP can be derived for the future?
The choice of the questions is not a theory escorted procedure. Several years of
practical professional experiences of the author were rather gone back to besides
theoretical knowledge. The questions are therefore indicated by a high practice
orientation.
Details
- Seiten
- Erscheinungsform
- Originalausgabe
- Jahr
- 2006
- ISBN (eBook)
- 9783956360213
- ISBN (Paperback)
- 9783832496401
- Dateigröße
- 1.1 MB
- Sprache
- Englisch
- Institution / Hochschule
- Hochschule für Angewandte Wissenschaften Hamburg – Gesundheitswissenschaft
- Erscheinungsdatum
- 2006 (Juni)
- Note
- 2,0
- Schlagworte
- gesundheitswesen gesundheitsförderung sgbv personal betriebliches
