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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 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) Number of cases • 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 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 hospital expences / year 34,0 % Expenses for MSD • 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 Number of musculoskeletal diseases Germany • 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 Endoprotheses in Germany acc. FBMTI joint type knee uni-condyle hip bi- condyle revision prim short diaphysis revision surface replacem. ankle shoulder Units in 2007 9.000 134.000 12.000 180.000 9.400 7.500 4.000 1.520 9.250 Actual survival curve age-group over 60 years Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06 Effect of age opposite health care costs Costs for health service per year - men Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06 Costs for health service per year - women Source: Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06 Increase of costs for health service from 1995 to 2004 Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06 Population of Germany 2000 and 2050 Quelle: Statistisches Bundesamt (2006 a) Demographical change 2000 - 2050 2040 2000 2010 2020 2030 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 10,0 + 222,6 Population employable age (20 to 65) / Mill. 51,2 50,0 48,0 42,4 38,4 7,9 2050 Changes 2000 until 2050 in % Classification 35,5 -30,7 Beske, F. u.a.: Gesundheitsversorgung 2050, Kiel 2007 Statistics of physicians Physicians altogether 407.000 - Thereof outpatient section - Thereof inpatient section - Thereof orthopeadic specialists 136.000 148.300 8906 BVOU ca. 6950 Members Orthopaedic Surgeons, mostly in private praxis Average age of physicians 55 50 45 Private praxis Hospital 40 35 30 1993 1995 1997 1999 2001 2003 2005 Physicians under the age of 35 30 25 20 15 % 10 5 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Students human medicine 95.000 90.000 85.000 80.000 75.000 70.000 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 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 Research funding • 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 Treatment options MSD* • 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 Objectives • individual and age-based health promotion • enhancing attractiveness of medical profession • investive social policy: prevention before rehab Thank you for your attention