The history of NWIn (Netzwerk Inanspruchnahme gesundheitsbezogener Leistungen in Deutschland/Health Care Utilization in Germany)

Given decades of socio-epidemiological research, the social gradients in health-related quality of life, morbidity, and mortality that favor higher and disadvantage lower social status groups are factually a truism. This holds true for Germany and Europe in general as well as for other industrialized countries such as the US or Canada. In Germany, for instance, differences in life expectancy between the highest and lowest income groups range up to 10 years. Against this background, a crucial scientific and political question is whether the health care system increases or decreases this gap. Initial 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 (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 presented medical sociological health care research in its full scope [1]. Subsequently, the special importance of the 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 „NWIn Research Network” [NWIn: „Netzwerk Inanspruchnahme” (German for „Utilization Network”)] in January 2010 for a three-year funding period. Prior to the book publication eventually intended by NWIn, a special issue of GMS Psycho-Social-Medicine (P-S-M) was published [2 – 8]. This publication already referred to the same theoretical approach, namely one of the leading frameworks for health care utilization research: the Behavioral Model of Health Care Utilization (BM) [9] [10] by the US medical sociologist and health services researcher Ronald M. Andersen. Among other things, it systematically reviews empirical studies that explicitly draw on the BM [3], scrutinizes the comparability of estimated prevalences of medical services use in large-scale population surveys in Germany [4], and presents first empirical findings. The present book carries this endeavor forward by being, to our knowledge, the first edited volume to analyze the social determinants of health care utilization in Germany via systematic use of Andersen and colleagues‘ BM as its recurrent theoretical approach throughout all chapters (starting with Chapter 2 in Part I), including a systematic update on relevant quantitative and qualitative research methods (Part II) and empirical results on selected predisposing and enabling factors (Part IIIa), need factors (Part IIIb), and sectors of care (Part IIIc).