Orthopaedics and Traumatology in Germany

1. Orthopaedics and Traumatology in Germany Prof. Dr. med. Joachim Grifka President of the German Orthopaedic Association 2008 Orthopädische Klinik für die Universität Regensburgim Asklepios Klinikum Bad Abbach

3. Private praxis

4. Area 357.092,90 km² Population 83 Million Population density 230 per km² Facts about Germany

5. Largest employment sector in Germany (over 4 Million jobs) 2.104 hospitals Appr. 1000 rehabilitation departments Health Care in Germany

6. 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) Costs of public health care

7. 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

8. Total expediture / year € 234 bil Thereof women / year € 3.160 per head Thereof men / year € 2.240 per head Thereof hospitalexpences / year 34,0 % Costs of public health care

9. 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

10. 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

12. 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

13. Costs for health service per year - men Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

14. Costs for health service per year - women Source: Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

15. Increase of costs for health service from 1995 to 2004 Niehaus, F.: Auswirkungen des Alters auf die Gesundheitsausgaben, WIP-Diskussionspapier 5/06

16. Population of Germany 2000 and 2050 Quelle: Statistisches Bundesamt (2006 a)

17. Demographical change 2000 - 2050 Beske, F. u.a.: Gesundheitsversorgung 2050, Kiel 2007

18. Physicians altogether 407.000 Thereof outpatient section 136.000 Thereof inpatient section 148.300 - Thereof orthopeadic specialists 8906 Statistics of physicians

19. ca. 6950 Members Orthopaedic Surgeons, mostly in private praxis BVOU

20. Average age of physicians

21. Physicians under the age of 35

22. Students human medicine

23. Certified surgeons

24. Founded in 1901 2448 members Amalgamation of German Orthopaedic Association and German Trauma Association in 2008 Annual congress in Berlin German Orthopaedic Association

25. 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

26. 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

27. Objectives • individual and age-based health promotion • enhancing attractiveness of medical profession • investive social policy: prevention before rehab

28. Thank you for your attention