Health care utilization in Germany: The NWIn research network.

Abstract

Recent national and international socio-epidemiological research has consistently demonstrated a significant social gradient in health-related quality of life, morbidity andmortality, favoring the higher and disadvantaging the lower social status groups. This holds true both for Germany and Europe in general as well as for other industrialized countries such as USA or Canada. For instance, in Germany differences in life expectancy between top and lowest income groups range up to 10 years. Against this background, a crucial scientific and political question is whether the health care system inor decreases this gap. First research findings in Germany indicate that the gap might be influenced more by differences in utilization than in supply. In 2002, the working group “Health Care Research” was founded within the German Association of Medical Sociology (Deutsche Gesellschaft fur Medizinische Soziologie, DGMS), consisting of about 30 scientists. In the following years, several workshops at national and international conferences were held by members of this group. In 2007, a first book resulted from this collaboration, which was published by Juventa and presentedmedical sociological health care research in its full scope [1]. Subsequently, the special importance of utilization of health care triggered a proposal to the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) for funding a scientific network on “Health care utilization in Germany”. After its approval (grant no.: JA-1849, 1-1), the network started off under the designation of NWIn Research Network (NWIn: “Netzwerk Inanspruchnahme”, i.e. “Utilization Network”) in January 2010 for a three years funding period. In 2013, a book publication provisionally entitled “Health care utilization in Germany: theory, methodology, and outcomes” is scheduled to be published by Springer Science + Business Media. As one of its key features, all chapters of this edited book will relate to one and the same theoretical approach, namely one (if not the) internationally leading framework for utilization research: the Behavioral Model of Health Care Utilization (BM) by US medical sociologist and health services researcher Ronald M. Andersen [2], [3]. Prior to this book publication, we are happy to present for the NWIn Research Network this special issue of GMS Psycho-Social-Medicine (P-S-M). In the first of six contributions, Birgit Babitsch, Daniela Gohl and Thomas von Lengerke via a systematic review assess the explicit use of Andersen’s BM in studies conducted in Europe or Anglo-American countries and published between January 1998 and March 2011 [4]. Although associations of higher utilization were found with older age, being a woman, higher income and poorer health, there were several inconsistencies across studies, among others that the operationalizations of the model revealed that only a small common set of variables was used, and that there were huge variations in the way these variables were categorized, especially in regard to predisposing and en-