"As a researcher, you think you can still change the world a little."

Prof. Dr Juliane Köberlein-Neu and the Bergisch Competence Centre for Health Economics and Health Services Research

"In my opinion, what really makes people healthy and keeps them healthy is knowledge," emphasises Dr Juliane Köberlein-Neu, Chairwoman of the Board of the Bergisches Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung, highlighting the responsibility of each person with regard to their own individual health. "In recent years, research has increasingly focussed on the personal responsibility of the individual," says the scientist, stating that one of the aims is to enable citizens and/or patients to take a consciously active role in their own healthcare. This in turn has the advantage that therapies are no longer imposed, but that the patient can "orientate themselves even more closely and better to a proposed therapy" and then implement what various stakeholders (doctor, pharmacist, therapist) suggest.

The concept of health literacy

And this requires three components. Köberlein-Neu formulates them as follows: "Awareness, an understanding of health and an active understanding of roles - these are the main components for everything. Once these foundations have been laid, it is also possible to compensate for deficits, which always exist, to a certain extent independently as a patient."

When it comes to interdisciplinary collaboration in research projects and healthcare, she would like to see more openness and understanding for the needs of the other profession and sees the different competences as a great opportunity rather than competition. She says: "When I work with other professions, nothing is taken away from me in terms of expertise, but I realise the opportunities. Interdisciplinary work increases mutual understanding, and recognising the skills of others helps you to accept your own limits."

Health economics - a new topic

Köberlein-Neu was one of the first to study the specific degree programme in health economics - at that time still in Cologne. She made a conscious decision not to study medicine and still makes it very clear to all new students who decide in favour of her subject due to a lack of sufficient numerus clausus that the combination of health economics and health management is a subject dominated by economics.

The interest in patients was decisive for her own decision to study and she says, "the object of desire is not numbers, but the patient", and each individual determines the direction of the degree programme for themselves. The professor explains: "When you study health economics, you can develop in different directions. You can orientate yourself towards economics, i.e. be primarily interested in the costs and economic effects of illness and inequality in society. But you can also say that I'm actually interested in healthcare. Then you are an idealist and think that as a researcher you could still change the world a little. That's the path I've chosen for myself."

Köberlein-Neu sees a number of advantages in healthcare research. Many issues can be addressed across disciplines and thus contribute to the further development of regional and supra-regional healthcare. She also sees many opportunities in interdisciplinary collaboration, "if I am actively interested in providing patients with comprehensive care, but do not claim to do it alone. And that's important."

Defining common goals

However, the path from theory to practice is a tough one. The first step is to look for project partners who are prepared to break new ground. Köberlein-Neu gives an example of this arduous search. "In one project, it took us over a year to bring pharmacists and doctors together, for example, and to make it clear to both of them that everyone has their place."

In her opinion, teamwork should have the big picture as its objective, because "interdisciplinary cooperation means that I am also interested in the other person and that I also talk openly and critically in advance about where there are fears," she emphasises, adding in conclusion, "you have to take the time to define a common goal that everyone can identify with."

"solimed ePflegebericht" - a regional project

The "solimed ePflegebericht" project in Solingen, which is funded by EFRE.NRW, the European Union and the state government of North Rhine-Westphalia, has found a goal defined in this way. The aim of the project is to test an electronic care report at the "touch of a button", which immediately provides those involved with the information they need to optimise medical and nursing care for geriatric patients. This reduces the documentation workload for nurses, carers and nursing staff on the one hand and keeps everyone involved informed at the same time on the other. Köberlein-Neu enthuses: "All the project partners have put their heart and soul into the project. I am delighted that we are able to provide scientific support for this innovative project." The project will run until 2020, but Köberlein-Neu hopes that this will result in further follow-up projects, as sustainable changes to care provision take time and perseverance.

The discrepancy between management and care

The Eisenach native is well aware of the discrepancy between management and nursing, but she also sees very clear opportunities for the future in her degree programme. "These degree programmes should lead to the development of managers who have the necessary awareness. On the one hand, they will be familiar with the care and needs of employees, but on the other hand, they will also be aware of the economic constraints." This is why she also motivates the students who are integrated into the profession, who often come from the care sector and have a completely different view of health economics. "They ask themselves much more often whether they have chosen the right degree programme, as they are actually there for people and not for management," explains Köberlein-Neu and motivates the students to persevere by explaining their later role as mediators in the system.

Prevention in ophthalmology

Over the next few years, the Wuppertal professor sees a focus in the field of ophthalmology, i.e. blindness/visual impairment, and believes she can make more of a difference in a specialised field, because: "Broad strategies reach many people, but only a few of the individual population groups." She therefore takes a selective approach, which takes longer but, like a map, becomes more comprehensive over time. In addition to analysing the economic consequences of blindness or visual impairment, her tasks also include developing evaluation concepts and raising awareness of commonly underestimated eye diseases such as macular degeneration (a retinal disease that can lead to blindness). Köberlein-Neu: "Blindness and visual impairment as a result of a disease is a problem of old age in Germany and I think it is very relevant because such diseases, which remain symptom-free for a very long time, are massively underestimated in the population." She believes that one of the tasks of health economics is to find reasons why the situation is like this and to ask why the population has such a low awareness of this issue.

A European perspective - where do we stand with our healthcare system?

"In Germany, the healthcare system is already quite good," she says firmly, "we are only lagging behind in terms of digitalisation." Nevertheless: "In other countries," she adds, "healthcare is much worse, but people often have a different basic attitude.

"What's more," she concludes mischievously, "Germans sometimes like to grumble a little."

But perhaps this dissatisfaction also spurs us on. According to an international study conducted by the University of Washington in Seattle in 2017, Germany ranks 20th out of 197 countries surveyed when it comes to medical care. There seems to be room for improvement. And what's more: "Dissatisfaction is the first step to success," said Oscar Wilde. And he wasn't even German.

Uwe Blass (interview from 24 January 2018)

Prof Dr Juliane Köberlein-Neu completed her doctorate at the Institute of Medical Statistics, Informatics and Epidemiology at the University of Cologne on the effectiveness of therapy guidelines in allergology. After completing her doctorate, she worked in the private sector. In 2010, she was appointed Junior Professor of Health Management in Wuppertal. There she heads the Bergische Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung (BKG).