Zur feststellung von bedarf an medizinischen rehabilitations-leistungen unter erwerbstätigen mitgliedern der gesetzlichen rentenversicherung

Assessing health care needs in populations has become a major activity of public health medicine worldwide. Its methodology has been developing mainly in the English-speaking world. Concept, methods, and techniques have not yet reached Germany though recently the national expert advisory council for the concerted action in health care (Sachverständigenrat for die Konzertierte Aktion im Gesundheitswesen) provided first "official" definitions of demand, supply, and need to identify over- and undersupply in health care. This article aims at defining, from a combined sociolegal and sociomedical perspective, the need for medical rehabilitation measures among insurees of German pension funds. According to § 15 SGB VI rehabilitation is conceived as a medically coordinated multimodal-multidisciplinary intervention with a cognitive-behavioural orientation. To objectify the need for rehabilitation a series of 9 questions was developed enquiring inter alia about the presence of a disease or disability, the extent or "amplification" of the disorder, its course pattern, the implied risk of permanent work disability and likely success of rehabilitation. Nonspecific back pain served as a paradigmatic condition. One of the main problems encountered is the presently small evidence base to arrive at the necessary prognostic and therapeutic judgements.