Key Aspects of a Sustainable Health Insurance System in Germany

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

The Community Health Experience Model-value generation from person-centered health transaction network

Background

Network society is creating new opportunities for value generation in all areas of our lives: new collaborative methods and tools are increasingly available for use by closely connected individuals and organizations. The stakeholders of the health ecosystem are potential winners of this networking process as a consequence of the increase in knowledge about health value generation supported by teamwork and collaborative approaches in this field.

Case Presentation

In this paper, we focus on the transactional nature of health value generation networks. First, we analyze the transactions in the networks. We then propose a design structure—the Community Health Experience Model—for effective person-centered health value generation networks. In the second phase of the work, we describe how the system design of the complete transaction network was tested in a real-life pilot environment focusing on fall prevention in individuals with osteoporosis.

As a result of the network-based collaborative service approach, fall risk decreased by 11.8% and the number of falls decreased by 4.5% within 3 months. Regarding the major health experience outcomes, self-evaluated condition-specific health literacy improved from 7.85 to 8.26 (an improvement of 0.41), while self-evaluated condition-specific self-management capability changed from 7.25 to 8.06 (0.81 improvement).

Conclusions

In conclusion, the proposed Community Health Experience Model is a novel and promising approach to designing the structure of more effective and efficient health services and collaborative networks.

Electronic supplementary material

The online version of this article (10.1186/s40985-018-0105-8) contains supplementary material, which is available to authorized users.