Scientific evaluation of the administrative management of reported cases of occupational skin diseases after the nationwide implementation of the "step wise procedure" (Stufenverfahren Haut) by the German Social Accident Insurance Institutions

Status:

completed 12/2010

Aims:

The administrative procedure "Skin" was introduced in 2005/2006 parallel to the optimized dermatological procedure. It is the effort of the administration to support the reduction of the rehabilitation and compensation expenses in the field of the occupational disease 5101 and simultaneously improve the quality of the rehabilitation of the insured.

Activities/Methods:

The research project VVH, together with the research project EVA_Haut examined 1,600 suspicious transaction reports of a work related skin disease in the Federal Republic of Germany from all social accident insurance institutions. The suspicious transactions were reported in the 4th quarter of 2007. The "follow-up" phase for these cases ended on December 31st, 2008. Afterwards, the concerned administration and insured, the treating dermatologists along with one or two experts on the accidents, with separate surveying instruments, expressed their opinions on the structure, process and outcome quality.

Results:

The research and evaluation project VVH, in connection with EVA_Haut has shown that the step-by-step process "Skin" was put in place and carried out with sufficient coverage from the social accident insurance institutions in the Federal Republic of Germany. A clear indication of this is the decreasing number of acknowledged cases of the occupational disease 5101 since 2005 (with a slightly rising number of annual notifications of suspicious occupational skin diseases). The summarized possibilities and measures in the step-by-step process "Skin" are to be used by the social accident insurance institutions as according to §3 BKV, and be employed as according to the step-by-step procedure. It has been shown, that through the application and implementation of the process steps of the step-by-step procedure "Skin", a high process quality is obtained, that is documented through an increasing result quality of its effect. The combination of different low-threshold actions, as according to §3 BKV, and especially the use of special procedures (skin protection seminars/special inpatient treatments), has lead to better results. The satisfaction of the stakeholders surveyed (dermatologists/the insured) with the step-by-step procedure "Skin" is very high.
Altogether it has been shown, that the carried out and implemented measures of the secondary and tertiary individual prevention in the report of suspicious activity of occupational disease 5101 have had a high investment nature and contribute to the avoidance, or rather the reduction of arising costs in the future. The "Return on Prevention" within this field is clearly occupied through the generation of a high net benefit. It would therefore be desirable, from a public health economic point-of-view to further observe this model of the secondary and tertiary individual prevention in its long-term effect and, if necessary, accompany the implementation of the measured variables of the process and outcome quality within the different administrations. Overall, the further implementation and standardization of processes of the statutory accident insurance bodies within the area of the evaluated proceedings should be pursued and an even stronger involvement of the business as a stakeholder should also be sought.
It would also be important and conducive from a public health and especially economical point-of-view to develop more models for the secondary and tertiary individual prevention for work-related diseases and, whenever necessary, also chronic diseases with long working inability allowances. Through the precisely targeted use of the method a high net benefit is achievable. In the future, the use of funds for preventative purposes could be carried out with more success and better targeted.

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