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Klin Monbl Augenheilkd 2025; 242(05): 546-554
DOI: 10.1055/a-2556-4235
Klinische Studie

Paediatric Ophthalmological Care in Large Ophthalmology Centres in Comparison to the Entire Specialist Group

Artikel in mehreren Sprachen: deutsch | English
Ursula Hahn
1   Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland
2   Augenheilkunde, OcuNet, Düsseldorf, Deutschland
,
Joerg Michael Koch
3   Augenabteilung am St. Franziskus-Hospital Münster, Deutschland
,
Ulrich Kellner
4   Stellvertretender Ärztlicher Leiter, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH, Deutschland
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Summary

Background Paediatric ophthalmological care is suffering from a thinning care network. Two (of several) possible causes are the increasing number of new forms of organisation (large contract medical facilities in terms of number of patients, doctors and locations) and medical care centres (MVZ) in non-physician ownership.

Methods In a network of large ophthalmological care facilities, paediatric ophthalmological care activities per provider were surveyed for 2019 for all providers according to the proportion of the number of cases and structural characteristics (number of locations with orthoptists and sites with paediatric surgery), evaluated overall and in the subgroups according to ownership (non-physician or physician ownership) and compared with specialist group-related comparative data.

Results With the one exception of a physician ownership provider, all providers (total n = 15, 12 of which were physician-owned) treated children < 6 years. In 2019, a total of 90,461 statutory health insurance (SHI) cases of children < 6 years were treated (9.3%of all SHI cases in children < 6 years in Germany). In the entire cohort, their share of all SHI cases was 3.7% (physician ownership: 4.8%, non-physician ownership: 3.2%). For the specialist group of all ophthalmologists in Germany, the average was 3.2% (difference not significant). Orthoptists worked at a total of 98 locations (58 physician ownership, 40 non-physician ownership, difference significant [p = 0.03]). Outpatient and inpatient paediatric surgery were offered by all non-physician owned providers and some physician owned providers.

Conclusions In this first large study on paediatric ophthalmic care in relation to the provider, the contribution of the newer types of organisation was evaluated. In comparison to traditional practices, there was no systematically different orientation – either for the whole study group or for any type of provider, as based on the relative proportion of children with SHI insurance or structural indicators (orthoptists or, outpatient or inpatient surgical care).

Fazitbox

  • Konservative wie chirurgische Kinderophthalmologie leidet unter problematischen (finanziellen) Eckdaten; das Angebot dünnt aus.

  • Die Versorgung von Kindern erfolgt weit überwiegend ambulant; die vertragsaugenärztliche Fallzahl von GKV-Versicherten < 6 Jahren betrug 2019 knapp 1 Mio.

  • Diskutiert wird, dass mit steigender Zahl von nach Patienten-, Arzt- und Standortzahl großen Trägern respektive Trägern in nichtärztlichem Fremdbesitz (neuer Organisationsformen im Vergleich zu traditionell geprägten Praxen) das vertragsärztliche Angebot weiter ausdünnen könnte.

  • Auf eine Kohorte von Trägern neuerer Organisationsformen entfielen 2019 9,3% aller Behandlungsfälle von Kindern < 6 Jahre.

  • Die Fallzahlanteile (Anteil Kindern < 6 Jahre) lagen in der Gesamtkohorte mit 3,7% (Träger in ärztlichem Eigenbesitz 4,8%, in nichtärztlichem Fremdbesitz 3,2%) über bzw. auf dem Niveau der Fachgruppen (3,2%), die Unterschiede waren durchweg nicht signifikant.

  • Das Versorgungsnetzwerk wurde entlang der Indikatoren Anteil Standorte mit Orthoptistinnen und ambulant- resp. stationär-chirurgisches Angebot beschrieben.

  • Die in die Studie einbezogenen neueren Organisationsformen lassen keine systematisch andere Ausrichtung in der kinderophthalmologischen Versorgung gegenüber traditionellen Praxen nach Anteilen Kindern und Versorgungsnetzwerk erkennen.

Conclusion Box

  • Conservative as well as surgical paediatric ophthalmology suffers from problematic (financial) key data; the provision of care is thinning out.

  • Paediatric care is largely provided in an outpatient setting; the number of contractual ophthalmological cases of GKV insured persons < 6 years in 2019 was just under 1 million.

  • It is discussed that with the increasing number of large-scale providers – based on patient, doctor, and location numbers – and providers owned by non-medical third parties (new organisational forms compared to traditionally structured practices), the contracted medical services might further diminish.

  • In 2019, a cohort of providers of newer organisational forms accounted for 9.3% of all paediatric treatment cases < six years.

  • In the overall cohort, the proportion of cases involving children under six years was 3.7% (with physician-owned providers accounting for 4.8% and non-medical third-party ownership accounting for 3.2%) over or at the level of the specialist groups (3.2%). The differences were generally not statistically significant.

  • The supply network was described along the indicators “proportion of locations with orthoptists” and “outpatient or inpatient-surgical offer”.

  • The newer forms of organisation included in the study do not systematically reveal a different orientation in paediatric ophthalmological care compared to traditional practices in terms of proportion of children and care network.

Keywords

paediatric ophthalmology - ownership diversity - strabology - ambulatory health care centre


Publikationsverlauf

Eingereicht: 11. Oktober 2024

Angenommen: 07. März 2025

Artikel online veröffentlicht:
21. Mai 2025

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