In this section, national initiatives which have been set up in Germany can be found.
Managed Care Programme: "Second opinion" / "Back to Work"
Cooperation of German health insurance and pain specialist society
1) "Second opinion for back pain patients" (Zweitmeinung)
In April 2010, German health care insurer (TK Krankenkasse) in cooperation with one of the German pain specialist societies started a project called "second opinion for back pain". According to a press release by the TK Krankenkasse insurance in Germany, every year about 230.000 patients are operated due to back pain.
Frequently, the original complaint - back pain - remains or returns. Patients often complain that after the back operation the pain became worse.
According to data provided by the insurance about 80% of these back operations (intervertebral discs) are not needed as they could have been cared of with conventional (pain) care.
For patients referred for a back operation, the insurance offers the possibility to get a very fast second opinion with a specialized pain care team without waiting time (within 2 days). In case the pain specialist and patient agree upon an pain therapy alternative to the back surgery the pain therapy is reimbursed. The pain treatment will then be performed by a cross-functional team where pharmaceutical treatment is only one of the available instruments. In case the pain treatment is unsuccessful the back surgery still can take place.
For the healthcare insurance the costs of a back surgery are much higher than pain care; for the patient the risk is much lower. For pain specialists the advantage is that they get to see the patient while measures still can be taken. The only ones losing in this managed care program seem to be the surgeons. Due to the long waiting lists they have not complained.
According to a 2011 German press article 85% of the patients within this programme were not confirmed for their back surgery.
2) "Back to Work"
The same cooperation initiated a project to bring back patients back to work. Patients unable to work due to back problems the insurance offers a managed-entry pain care program (medical doctors, psychologists and physiotherapists). This project was presented at the symposium on the Societal Impact of Pain (SIP) 2010 by the CEO of this insurance Prof. Norbert Klusen.
From over 3.700 patients included in this program in a 4 - 8 week therapy program 49% was free of pain after 4 weeks and 84% returned to work after 8 weeks. Six month later still over 90% of the former patients was still working. Modest calculations show the insurance saves at least 5000€ per patient (see "Informationsdienst Wissenschaft").