Selective contracts for chronic wounds: current state in Germany

Background. Patients with chronic wounds often have a high morbidity which requires great amounts of medical and nursing efforts and are consequently associated with high costs usually for a long period of treatment. By the conclusion of selective contracts statutory health care insurances and healthcare providers can improve the management of complex diagnoses by implementing structured treatment processes and individual compensation solutions in terms of a better quality and better efficiency while maintaining quality. At present little is known about the availability of selective contracts for chronic wounds in Germany. Objective. The aim of the study was to examine and present the existing selective contracts of the statutory health insurances for chronic wounds in Germany. Methods. A nationwide survey addressing all representatives of the statutory health insurance in Germany was carried out. Results. The response rate was 21% (n=27). Out of 131 contacted health insurances 59.3% had selective contracts for treatment of chronic wounds, whereby contracts of integrated care were most common (84.8%). The most frequent diagnosis which was part of the selective contracts was diabetic foot syndrome (69.7%). The most frequent contractors were office-based physicians (66.7%), followed by hospitals (48.5%) and management companies (30.3%). A total of 20,068 patients with chronic wounds were treated currently and in the past in the context of selective contracts. Conclusion. With an estimated prevalence of 1.7 million patients with chronic wounds and statutory health insurance, only 2.4% were treated in the context of selective contracts. There remains a great need for improved structures of care and reimbursement structures in the treatment of chronic wounds. Selective contracts should contain clearly established guideline-and evidence-based targets for the treatment of patients with chronic wounds. An evaluation and transparency of the results should be considered obligatory.