Beh ens, Y onne; Mo ia, Madlene; Mache , Sand a; Amo , F ank M.
Resea ch Repo
Success ul managemen o heal h egions: Ci cums ances,
challenges and compe ences in Ge man heal h egions
i gs Sch i en eihe de FOM, No. 29
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Success ul managemen o heal h egions: Ci cums ances, challenges and compe ences in Ge man
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Success ul Managemen o Heal h Regions:
Ci cums ances, Challenges and Compe ences
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Y onne Beh ens, Madlene Mo ia, Sand a Mache ,
F ank M. Amo
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gs
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ü Oekonomie & Managemen
Y onne Beh ens, Madlene Mo ia, Sand a Mache , F ank M. Amo
Success ul Managemen o Heal h Regions: Ci cums ances, Challenges and Compe ences
in Ge man Heal h Regions
i gs Sch i en eihe de FOM, Band 29
Essen 2024
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Success ul Managemen o Heal h Regions
Ci cums ances, Challenges and Compe ences
in Ge man Heal h Regions
Y onne Beh ens, Madlene Mo ia, Sand a Mache , F ank Amo
Con ac :
Y onne Beh ens M.A.
FOM Uni e si y o Applied Sciences
E-Mail: y onne.beh [email p o ec ed]
Published in E asmus+ P ojec :
Compe ences in Heal h Ne wo k Managemen
P ojec -ID: 2019 – 1 – DE01 – KA203 ‒ 005025
The c ea ion o hese esou ces has been (pa ially) unded by he ERASMUS+
g an p og am o he Eu opean Union unde g an no. 2019 1 DE01 KA203
005025. Nei he he Eu opean Commission no he p ojec ‘s na ional unding
agency NA DAAD a e esponsible o he con en o liable o any losses o dam-
age esul ing o he use o hese esou ces.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
III
P e ace
Heal h egions ha e been an in eg al pa o se e al Ge man s a es o mo e han
en yea s. Thei composi ion and opics o in e es a e he e ogeneous, as his
publica ion poin s ou . As a as his he e ogenei y is conce ned, du ing he de-
elopmen phase o he heal h egions in he con ex o a ede ally s uc u ed
Republic, he e we e only wo na u ally guiding p inciples: he wel a e s a e and
social solida i y; bo h a e egula ed as unchangeable, e e nally alid p inciples in
he Ge man “G undgese z”. A numbe o ede al s a es used he emaining oom
o in e p e a ion and disc e ion o es ablish s a e-wide s uc u es o heal h e-
gions. This i gs olume epo s on i e o hese egional solu ions based on a
b oad li e a u e su ey and a guideline-based in e iew in each case.
The COVID-19 pandemic eg e ably demons a ed he limi a ions o heal h e-
gions. The ew manage s al eady wo king ull- ime we e o en eassigned o pan-
demic- ele an a eas o he public heal h se ice (“Ö en liche Gesund-
hei sdiens ”), wi h massi e, non-COVID- ela ed consequences o heal h ca e
wi hin he popula ion. A mul i ude o s udies e e ence a de e io a ion in his e-
ga d wi h a simul aneous inc ease in indi iduals’ beha iou becoming a heal h
isk. As is well known, his pa icula ly a ec ed he u ban esiden ial popula ion,
again ocused on he so-called high- isk a eas. As a solu ion o his, he Ge man
go e nmen is cu en ly pushing he so-called “heal h kiosks”, o which a o al o
1,000 a e o be c ea ed o he 374 egional heal h o ices in he cu en 20 h
legisla i e pe iod (2021‒2025). Models o his a e wo such ins i u ions in Ham-
bu g-Bills ed and Be lin-Neukölln. I is cu en ly un o eseeable, how heal h e-
gions will be main ained and how heal h kiosks a e o be es ablished. The objec-
i es p oclaimed in he “Pac o he Public Heal h Se ice” launched in 2021 ou
o acu e g ie ances a e high. Howe e , he heal h kiosks a e no explici ly men-
ioned. Should hey be es ablished and ins i u ionalized a he same ime as he
pac , i is p obable ha hey will eplace he asks o egional heal h concep s.
In o de o make an impac as quickly as possible, he modula lea ning sys em
elabo a ed on in he E asmus+ p ojec “Compe ences in Heal h Ne wo k Man-
agemen ” could be gi en adequa e impo ance in a na ionwide oll-ou .
Munich, Janua y 2024
P o . D . habil. Man ed Cassens
Resea ch Di ec o o he Ins i u e o Heal h & Social A ai s (i gs)
a FOM Uni e si y o Applied Sciences
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
IV
Abs ac
Backg ound
Heal h egions a e associa ions o a wide a ie y o pe sons in ol ed a egional
le el who a e connec ed o he heal h sec o . Along wi h di e en p o essions,
hese playe s ep esen a wide ange o in e es s. Regional Heal h Ne wo k Man-
age s manage he heal h egions in o de o imp o e he heal h o he egional
popula ion (c . Landes e einigung ü Gesundhei and Akademie ü Sozi-
almedizin Niede sachsen 2018; Buck e al. 2019). The E asmus+ p ojec
Com.HeNe su eyed he (in e -)na ional compe ences o egional heal h ne -
wo k managemen .
Me hod
In o de o iden i y he equi ed compe ences o egional heal h ne wo k man-
agemen , he p ojec conso ium conduc ed a comp ehensi e li e a u e e iew.
Fo his pu pose, a ious scien i ic a icles as well as g ey li e a u e we e used.
In addi ion, i e in e iews pe coun y we e conduc ed wi h expe s in he ield o
heal h egions. The esul s we e compiled and analysed o he equi ed compe-
ences o egional heal h ne wo k managemen .
Resul s
The s udy e ealed ha he e is nei he a uni o m de ini ion no a uni o m aining
o egional heal h ne wo k managemen in Ge many. The expe s ecommend
he inclusion o s akeholde s om he ields o heal h, economy, poli ics, science
and socie y in he ne wo k. P o essional, scien i ic, p ac ical and pe sonal com-
pe ences a e necessa y o he managemen o heal h egions.
Conclusion
The managemen o heal h egions is an in e disciplina y ield o wo k. In addi ion
o p o essional compe ences, pe sonal compe ences a e also needed. The
Com.HeNe p ojec iden i ied he compe ences o egional heal h ne wo k man-
agemen .
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
V
Table o Con en s
P e ace ............................................................................................................... III
Lis o Tables ..................................................................................................... VII
Lis o Abb e ia ions .......................................................................................... VII
1 In oduc ion ..................................................................................................... 1
2 Resea ch Ques ions and Me hods ................................................................. 3
2.1 Li e a u e Resea ch ................................................................................ 3
2.2 Expe In e iews .................................................................................... 4
3 Resul s and Discussion .................................................................................. 6
3.1 Ci cums ances, S uc u es and Challenges in Ge many ........................ 6
3.1.1 Main Heal h Challenges ............................................................. 6
3.1.2 Key Ins i u ions ........................................................................... 7
3.1.3 Key Policies in he Field o Heal h Regions ............................... 7
3.1.4 Heal hca e Sys em ..................................................................... 8
3.1.5 Heal h Ta ge s ......................................................................... 10
3.2 Heal h Ne wo k Manage ...................................................................... 12
3.2.1 Desc ip ion ............................................................................... 12
3.2.2 S a us Quo in Ge many ........................................................... 13
3.2.3 Challenges ............................................................................... 13
3.2.4 Compe ences and Tasks ......................................................... 13
3.2.5 Financing and Adminis a ion .................................................. 16
3.2.6 So wa e ................................................................................... 16
3.3 Resul s o he Conduc ed In e iews .................................................... 17
3.3.1 In e iew Rhineland-Pala ina e and Hesse .............................. 17
3.3.2 In e iew Ba a ia ..................................................................... 20
3.3.3 In e iew Lowe Saxony ........................................................... 22
3.3.4 In e iew No h Rhine-Wes phalia ........................................... 24
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
VI
3.3.5 In e iew Saa land ................................................................... 26
3.3.6 Summa y o he In e iews ...................................................... 27
3.4 Discussion and Conclusion .................................................................. 29
3.4.1 S eng hs and Weaknesses o he Resea ch Me hods ........... 29
3.4.2 Summa y o he Resul s .......................................................... 29
3.5 Recommenda ions o S akeholde s and Policy Make s ...................... 30
3.6 Recommenda ions o Regional Heal h Ne wo k Manage s
in Ge many ........................................................................................... 31
Bibliog aphy ....................................................................................................... 32
Fu he Publica ions Resul ing om he P ojec Compe ences in Heal h
Ne wo k Managemen .................................................................................. 37
Appendix ............................................................................................................ 39
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
6
3 Resul s and Discussion
In he ollowing chap e s, he esul s o he li e a u e esea ch and he expe
in e iews a e p esen ed and discussed. A e he p esen a ion o he
ci cums ances, s uc u es and challenges in Ge many, he desc ip ion o he
p o ession o a Heal h Ne wo k Manage ollows. The la e is based on li e a u e
esea ch and expe in e iews, he o me me ely on li e a u e esea ch. A
summa y is ollowed by ecommenda ions o s akeholde s, policy make s and
egional Heal h Ne wo k Manage s in Ge many.
3.1 Ci cums ances, S uc u es and Challenges in Ge many
Wi hin his chap e , main heal h challenges as well as key ins i u ions o he Ge -
man heal h sys em will be p esen ed. Fu he mo e, he Ge man heal h ca e sys-
em and i s key policies will be in oduced. Finally, he heal h a ge s will be de-
sc ibed.
3.1.1 Main Heal h Challenges
Demog aphic change is one o he g ea es challenges o he Ge man heal h
sys em: he highe he li e expec ancy, he g ea e he likelihood o mul imo bidi y.
This in u n equi es mo e specialis s a in ca e and ea men (c . Buck e al.
2019, p. 448). Ano he challenge lies in unnecessa y diagnos ic and he apeu ic
measu es. This c ea es cos s o pa ien s and he heal h sys em (c . Eymann e
al. 2018 p. 4). The highes heal h isk ac o s a e p ima ily based on he popula-
ion’s beha iou . In 2015, he numbe o beha iou al induced illnesses was
28 pe cen o all cases. The main p oblems include alcohol consump ion, obacco
use, and obesi y (c . OECD/Eu opean Obse a o y on Heal h Sys ems and Poli-
cies 2017, p. 4‒5). The alcohol consump ion pe adul in Ge many is a o e 10
li es (s a us 2022, c . Bundesminis e ium ü Gesundhei 2022). O e 23,8 pe -
cen o he Ge man popula ion smoke (s a us 2021, c . Bundesminis e ium ü
Gesundhei 2021) and o e 19 pe cen a e obese (s a us 2019/2020, c . Robe
Koch Ins i u 2021). I is s iking ha beha iou - ela ed isk ac o s occu pa icu-
la ly equen ly in dep i ed popula ion g oups (c . OECD/Eu opean Obse a o y
on Heal h Sys ems and Policies 2017, p. 4‒5).
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
7
3.1.2 Key Ins i u ions
In Ge many, he p inciple o solida i y exis s on a ede al le el. This means ha
all hose wi h s a u o y heal h insu ance join ly bea medical cos s in Ge many.
The Ge man managemen p inciple in he heal h sec o is complex. The Ge man
ede al go e nmen se s he amewo k and asks in medical ca e in he o m o
laws and egula ions. The exac o ganiza ion and design is handled by he join
sel -adminis a ion in he heal h ca e sys em. This includes ep esen a i es o he
medical, den al and psycho he apeu ic p o essions, hospi als, heal h insu ance
companies and he insu ed (c . Bundesminis e ium ü Gesundhei 2020, p. 10).
The highes decision-making body is he Fede al Join Commi ee (G-BA) (c .
OECD/Eu opean Obse a o y on Heal h Sys ems and Policies 2017, p. 6). Go -
e nmen al asks in Ge many a e di ided acco ding o he p inciple o subsidia i y.
The municipali ies a e ini ially esponsible o he popula ion. This is pa ly be-
cause he municipali ies a e in close con ac wi h he ci izens. They a e also e-
sponsible o local heal h ca e and p e en ion se ices. An impo an ask is o
ensu e equal oppo uni ies o he popula ion in he heal h sec o . The ede al
s a es can d a and implemen hei own laws. Finally, he ede al go e nmen
p o ides he poli ical amewo k (Bundesminis e ium ü Gesundhei 2020, p. 13).
The e a e no consis en egula ions o he adminis a ion o managemen o Ge -
man heal h egions. In Ge many, heal h egions wo k wi h minis ies (c . Baye -
ische S aa skanzlei 2019) such as he Ba a ian S a e Minis y o Heal h and
Ca e, o closely wi h heal h au ho i ies (sou ce: in e iews wi h expe s, see chap-
e 4.2).
3.1.3 Key Policies in he Field o Heal h Regions
The e is no na ionwide consis en legal si ua ion o heal h egions. As an exam-
ple, he legal egula ion o he ede al s a e o Ba a ia will be ou lined. This con-
ce ns he guideline o he p omo ion o Gesundhei s egionenPlus (GRplusFöR;
heal h egions plus). The announcemen was made unde he e e ence numbe
P2a-G8010-2019/35-69. The egula ions a e alid o he pe iod om 2019 o
2022 and he objec o he unding is he es ablishmen and main enance o unc-
ioning coope a ion and coo dina ion s uc u es a municipal le el. C oss-sec o al
coope a ion on si e is desi ed. Possible ecipien s o unding a e coun ies, inde-
penden ci ies and associa ions o coun ies as well as independen ci ies. The
unding is ied o a ious condi ions:
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
8
• Es ablishmen o an o ice, heal h o um and wo king g oups
• Implemen a ion o he ields o ac ion ac i e heal h p omo ion and p e-
en ion, heal h ca e and nu sing
• Annual submission o an implemen a ion plan
• Biannual p og ess epo a he S a e O ice o Heal h and Food Sa e y
(LGL)
• Pa icipa ion in he o e all e alua ion o all Gesundhei s egionenplus by
he S a e O ice o Heal h and Food Sa e y (LGL)
A g an is awa ded o a maximum o ou yea s. The subsidy o he b anch o -
ices is up o 50,000 eu os a yea . This is he case i a ull- ime posi ion is imple-
men ed. I i is a pa - ime posi ion, he amoun will be adjus ed acco dingly.
The in e nal ela ionship o heal h egions mus be egula ed by a coope a ion
ag eemen . The ag eemen cla i ies he ques ion o ep esen a ion and liabili y.
The liabili y o eimbu semen claims conce ns all membe s o he ne wo k (c .
Baye ische S aa skanzlei 2019).
Fo a mo e in-dep h desc ip ion o he s uc u e o heal h egions, I ecommend
he ex book “Compe ences in Heal h Ne wo k Managemen ‒ A Tex book o
T aining Regional Heal h Ne wo k Manage s” (Beh ens e al. 2022). The ex book
is based on he iden i ied in e na ional compe ences o egional heal h ne wo k
managemen om he Com.HeNe p ojec . I o e s comp ehensi e knowledge as
well as asks o he deepening o he ollowing opics: Heal h Regions, Heal h
and Socie y ‒ heo e ical Backg ound, Heal h Needs Assessmen , P omo ing he
Ne wo k, P ojec Managemen , S a egic Managemen and Planning, Da abase
Sys ems, Da a P o ec ion and Secu i y.
3.1.4 Heal hca e Sys em
The Ge man heal hca e sys em has a complex s uc u e. The legal amewo k is
de e mined by he Ge man go e nmen . The egula o y de ails a e de e mined
ia guidelines by he join ede al commi ee. This is he highes sel -go e ning
body. The ede al s a es moni o he sel -go e ning bodies a he s a e le el. In
Ge many, he ede al s a es a e esponsible o hospi al planning, in es men s
and medical aining (c . Beh ens e al. 2020, p. 7‒8).
Heal h expendi u e in Ge many amoun s o o e 441 billion eu os (s a us 2022,
c . DESTATIS S a is isches Bundesam 2022). Pe inhabi an , he expendi u e is
5298 eu os (s a us 2020, ibid.). A ela i ely s ong sec o sepa a ion leads o di -
icul ies in ou pa ien and inpa ien ca e (c . Goldschmid 2020, p. 90), causing,
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
9
among o he s, inancial bu dens and inc easing p essu e o e iciency. This
leads o in e ace, coo dina ion, communica ion and coope a ion p oblems. One
consequence may be poo e ea men o pa ien s (c . Buck e al. 2019, p. 449).
Be e ne wo king could imp o e pa ien ca e and adminis a i e p ocedu es
could be simpli ied (c . Goldschmid 2020, p. 90).
S uc u al p oblems in he heal h sec o a e pa icula ly p e alen in u al a eas.
Especially in u al a eas, many su ge ies and clinics a e closing. In addi ion, pa-
ien s some imes ha e o a el e y long dis ances o specialis s and clinics. Be -
e ne wo king among he playe s in he heal hca e sys em could also be help ul
he e (c . Buck e al. 2019, p. 449‒450).
The s uc u e o he Ba a ian Gesundhei s egionenplus is p esen ed as an exam-
ple o he managemen o a heal h egion. In he s a e o Ba a ia, he es ablish-
men o heal h egions has been suppo ed since he yea 2015. The heal h e-
gions a e ancho ed a he municipal le el and should no be implemen ed in ad-
minis a i e dis ic s ha a e below he adminis a i e le el o a dis ic (K eis) o
independen ci y (K eis eie S ad ). The aim o he unding is o s eng hen he
ne wo king o heal hca e s akeholde s. The Gesundhei s egionenplus ha e a
h ee-pa s uc u e: coo dina ing o ice, es ablishmen o a heal h o um, and es-
ablishmen o opic- ela ed wo king g oups.
The o ice is he con ac pa ne o he people in ol ed in he egional heal hca e
sys em. I should be a ached o he Dis ic O ice o he Heal h O ice. I is e-
sponsible o managing he heal h egion, which includes coo dina ing he heal h
egion, ans e ing in o ma ion be ween he commi ees and moni o ing he im-
plemen a ion plan. The Heal h Fo um is he cen al managemen and con ol in-
s umen o he heal h egion. I is a body in which di e en playe s om he e-
gional heal hca e sys em pa icipa e. The Heal h Fo um should ake place a leas
once a yea . Policy- ele an opics on heal h p omo ion and heal hca e a e dis-
cussed. The o ien a ion o he opic- ela ed wo king g oups is de e mined he e.
These a e dedica ed o indi idual opics. The ele an ac o s and expe s discuss
he p esen p oblems and de elop p oposals o solu ions (c . Hollede e e al.
2016, p. 2‒5).
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
10
3.1.5 Heal h Ta ge s
In Ge many, heal h objec i es a e unde s ood o be ag eemen s be ween he e-
sponsible s akeholde s in he heal hca e sys em, wi h he heal h o he popula ion
as he o e a ching goal. The aims a e o mula ed as ecommenda ions based on
p o ed e idence. They in eg a e a ious heal h policy aspec s and a e de eloped
by ep esen a i es o poli ics, unding agencies, se ice p o ide s, sel -help and
pa ien o ganiza ions, science and esea ch. Since 2000, en goals ha e been
o mula ed, which a e s ill o g ea impo ance.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
11
Table 1: P esen a ion o Heal h Objec i es in Ge many Including Expla-
na ion o he Objec i es
Heal h Ta ge De ini ion Publica ion
o Accompanying
Legisla i e Ac
Diabe es melli us
ype 2
Reduc ion o disease isk,
ea ly de ec ion and ea -
men
2003 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.i)
B eas Cance Reduc ion o mo ali y, in-
c ease in quali y o li e
2003 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.j)
Reduc ion o
Tobacco
Consump ion
P o ec ion om passi e
smoking, inc ease in
smoking cessa ion in all
age g oups
2003, Upda e: 2015 (Gesellscha
ü Ve siche ungswissenscha
und -ges al ung e. V., n. d.c)
G owing up in a
Heal hy Way
Li e skills, exe cise, nu i-
ion
2003, Upda e: 2010 (Gesellscha
ü Ve siche ungswissenscha
und -ges al ung e. V., n. d.k)
Inc easing Heal h
Li e acy, S eng h-
ening Pa ien
So e eign y
Inc easing anspa ency
in heal hca e, de elop-
men and expansion o
heal h li e acy
2003, Upda e: 2011 (Gesellscha
ü Ve siche ungswissenscha
und -ges al ung e. V., n. d.d)
Dep essi e
Diseases
P e en ion, ea ly de ec-
ion, sus ainable ea -
men
2006 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.l)
G owing Old
in a Heal hy Way
Social pa icipa ion, e-
duc ion o heal h isks, ap-
p op ia e demen ia ca e
2012 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.e)
Reduc ion o
Alcohol
Consump ion
Inc easing he awa eness
o p oblems, ea ly de ec-
ion o alcohol p oblems
2015 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d. )
Heal h A ound
he Bi h
Heal hca e, heal h a e -
ca e
2017 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.g)
Pa ien Sa e y
S eng hening pa ien
sa e y cul u e and pa ien
sa e y compe ence
2022 (Gesellscha ü Ve siche-
ungswissenscha und -ges al ung
e. V., n. d.a)
Sou ce: Own p esen a ion based on da a by Gesellscha ü Ve siche ungswis-
senscha und -ges al ung e. V., n. d.a‒l)
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
12
In 2020, he main ocus o wo k was on “G owing up in a heal hy way” and “G ow-
ing old in a heal hy way”. In addi ion o he na ional heal h a ge s, he e a e also
heal h a ge s o p io i y ields o ac ion ha a e speci ic o each ede al s a e (c .
Gesellscha ü Ve siche ungswissenscha und -ges al ung e. V., n. d.h).
Heal h egions can in luence heal h a ge s. Fo example, he Gesundhei s-
egionplus in he dis ic o Ansbach o mula es egional heal h goals a he Heal h
Fo um. The la e is he cen al s ee ing commi ee o he heal h egions (c . Ge-
sundhei s egionplus Landk eis Ansbach und S ad Ansbach, n. d.). He e, egional
needs and s a es o heal h a e eco ded in he a eas o heal hca e, p e en ion
and heal h p omo ion and subsequen ly iden i ied as heal h a ge s (c . Gesund-
hei s egion Bäde land Baye ische Rhön n. d.). The Gesundhei s egionplus in he
dis ic o Günzbu g also de elops egional heal h goals. This egion has, o ex-
ample, o mula ed he isualiza ion o he heal h o e s and he a ac i eness o
he dis ic as egional heal h objec i es (c . Landk eis Günzbu g. Die Familien-
und Kinde egion, n. d.).
3.2 Heal h Ne wo k Manage
The ollowing chap e p esen s he esul s o he li e a u e sea ch wi h ega d o
Heal h Ne wo k Manage s.
3.2.1 Desc ip ion
In Ge many he e is no uni o m de ini ion o he p o ession o a egional Heal h
Ne wo k Manage . Howe e , Heckes’ desc ip ion can be conside ed gene ally
alid. Abo e all, i illus a es he coo dina ion ask o he manage . Heckes s a es
ha a egional Heal h Ne wo k Manage
[...] is a se ice p o ide and consul an o se ices, [...] canno and
does no ha e o be an expe in he indi idual opics ‒ his ask lies
elsewhe e: i is o c ea e spaces in which all con ibu ions and mo i-
a ions om he a ious sec o s o as many as possible can be. We
[sic] a e no addi i e, bu in eg a ed (Heckes 2016, p. 62, own ans-
la ion).
Heal h egions consis o a wide a ie y o playe s om he egional heal hca e
sys em. In his sense, a egion is de ined as a dis ic o an independen ci y (c .
Landes e einigung ü Gesundhei und Akademie ü Sozialmedizin Niede sach-
sen 2018, p. 7). The aim o heal h egions is o bundle egional compe ences,
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
13
c ea e alue and hus secu e egional companies (c . Rundholz 2016, p. 31;
Jedamzik 2017, p. 58). In he long e m, hese goals esul in an imp o emen in
he heal hca e o he popula ion. Typical pa icipan s o heal h egions a e:
• Municipal ep esen a i es
• The Associa ion o S a u o y Heal h Insu ance Physicians
• S a u o y heal h insu ance unds
• Medical associa ions o local hospi als
• P ac ising doc o s
• Ou pa ien and inpa ien ca e acili ies
• Sel -help o ganisa ions
• Dis ic adminis a ions (c . Landes e einigung ü Gesundhei and Aka-
demie ü Sozialmedizin Niede sachsen 2018, p. 10).
Di e en s akeholde s ep esen di e en in e es s. The e o e, managemen is
needed o coo dina ion. This can be done by he egional Heal h Ne wo k Man-
age , who ac s as a media o in he ne wo k (c . Buck e al. 2019, p. 451).
3.2.2 S a us Quo in Ge many
In Ge many, he e is no consis en cu iculum o he aining o egional Heal h
Ne wo k Manage s. Howe e , he e a e guidelines o he es ablishmen and
managemen o heal h egions.
3.2.3 Challenges
The s ong sepa a ion o indi idual heal h ac o s in Ge many is a challenge o
egional Heal h Ne wo k Manage s. The eason o his sepa a ion is he high
complexi y o he Ge man heal h sys em (c . Buck e al. 2019, p. 451). A u he
challenge is he s ong selec ion o he sec o s and indus ies in ol ed. Wi hin he
ne wo k, oles mus be dis ibu ed and s uc u es de eloped (c . Ke ne -Nikolaus
2017, p. 24). The challenges also include o e coming mis us among pa ne s
and echnical hu dles in communica ion (c . Ange e e al. 2017, p. 9).
3.2.4 Compe ences and Tasks
Fo a success ul es ablishmen o a heal h egion as well as a success ul man-
agemen , e sa ile compe ences a e needed. The ange o asks o egional
Heal h Ne wo k Manage s is wide. Cen al asks include he ini ia ion, planning,
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
14
implemen a ion and p o essional suppo o egional de elopmen p ocesses. Ad-
di ional asks in ol e, among o he s, he s eng hening o skills o specialis s (c .
Rundholz 2016, p. 33).
Acco ding o Buck e al. (2019), pa o hese asks a e in as uc u e, mode a ion,
p omo ion and go e nance.
Table 2: O e iew o he Co e Func ions o Ne wo k Managemen
In as uc u e Mode a ion P omo ion Go e nance
• Resou ce
managemen
• IT s a egy
• In o ma ion
sys ems &
communica ion
channels
• Role unde s anding
& esponsibili y
• In ensi y o
coope a ion
• Communica ion &
collabo a ion
• Se ice o e s o
ne wo k membe s
• Ne wo k cul u e
• Membe ec ui -
men & admin-
is a ion
• P omo ion
s a egy
• Ne wo king wi h
ex e nal in e es
g oups
• Legal o m &
con ac s
• Decision-mak-
ing mecha-
nisms
• Ne wo k s a -
egy & goals
• Sus ainable
inancing model
• Pe o mance
moni o ing
Sou ce: Own p esen a ion based on da a by Buck e al. 2019, p. 10‒17.
In as uc u e includes he managemen o esou ces, which con ains inances,
and pe sonnel and physical esou ces (c . Buck e al. 2019, p. 452). The secu ing
o inancial esou ces should be a ge ed h ough sys ema ic and a ge ed acqui-
si ion o inance. In his way long- e m ne wo king can be achie ed. An annual
in es men and p ojec plan should be d awn up o p o ide a sound basis o
discussion (c . Beh ens e al. 2018, p. 10). Fu he mo e, he IT s a egy and sui -
able communica ion ools o he ne wo k a e de eloped o selec ed in his a ea.
Clea communica ion o he selec ed channels is c ucial o a oid misunde s and-
ings (c . Buck e al. 2019, p. 452‒453). In addi ion o i ual communica ion, pe -
sonal exchange is e y impo an in ace- o- ace mee ings. These o e good op-
po uni ies o build a ela ionship o us (c . Beh ens e al. 2018, p. 11).
The mode a ion o he ne wo k is usually done by he managing di ec o . This
ield o ac ion includes a sensible alloca ion o esou ces. In addi ion, asks a e
alloca ed o he indi iduals in ol ed in a way ha is ailo ed o hei needs. I
should be no ed ha he playe s ha e he app op ia e skills and capaci ies. The
a ea mode a ion is cha ac e ized by ope a ional managemen . Bo h in e nal and
ex e nal inqui ies a e handled he e. I is a neu al suppo o he communica ion
p ocesses. This can also be unde s ood as a media o . In o de o elie e hose
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
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in ol ed, su eys can be conduc ed o de e mine he need o suppo (c . Buck
e al. 2019, p. 454‒456). In addi ion, he ans e o in o ma ion be ween he indi-
idual commi ees is also impo an (c . Hollede e e al. 2016, p. 4). I is ecom-
mended ha a code o conduc is ag eed upon and p ocesses a e clea ly de ined
(c . Eymann e al. 2018 p. 15).
Go e nance includes he s a egic le el o he ne wo k. An o e a ching ne wo k
s a egy is de eloped oge he wi h he s akeholde s. O he asks include he in-
s i u ionaliza ion o o ms and mechanisms o go e nance. The esponsibili y
s uc u e is decen alized, as i is o ien ed owa ds he ne wo k. In addi ion, he
o mal and in o mal ules o coope a ion wi hin he ne wo k a e de ined and con-
ac ually ag eed upon. This is pa icula ly impo an a he beginning o coope -
a ion in he ne wo k. In his way esponsibili ies can be assigned and eliable
s uc u es can be es ablished. Go e nance also includes he con ol and docu-
men a ion o e en s in he ne wo k (c . Buck e al. 2019, p. 454‒455). In he Ge-
sundhei s egionplus (Ba a ia), o example, a semi-annual p og ess epo mus
be p oduced (c . Hollede e e al. 2016, p. 4). Ini ially, mos heal h egions a e
ounded as associa ions, hen an o ganiza ion wi h i s own legal o m is es ab-
lished. The ollowing legal o ms a e ecommended o managing a heal h egion:
GmbH and GmbH & Co KG (c . Buck e al. 2018, p. 12).
The a ea o p omo ion deals wi h public ela ions wo k. I includes he c ea ion o
a uni o m co po a e design, he pe cep ion o ade ai appea ances and he ne -
wo k’s In e ne p esence. In addi ion, new membe s a e solici ed he e. I is im-
po an o de e mine an o e a ching p omo ion s a egy o he ne wo k (c . Buck
e al. 2019, p. 456) and o communica e i . Good public ela ions wo k can esul
in inancial suppo o he ne wo k, o example, h ough close con ac wi h public
ins i u ions. A no ime, he sponso s’ in e es s should ha e p ecedence be o e
hose o he ne wo k (c . Buck e al. 2019, p. 457). P omo ion also includes he
o ganiza ion o e en s ha in o m he public abou he ne wo k and i s wo k.
These e en s could be con e ences, symposia o u he aining cou ses. Fo
ac i e main enance o he ne wo k, he c ea ion and dis ibu ion o a newsle e
is ecommended (c . Beh ens e al. 2018, p. 16‒17).
Regional Heal h Ne wo k Manage s need pa icula pe sonal a ibu es. These
include good coo dina ion, communica ion and in e pe sonal skills as well as em-
pa hy. The s akeholde s’ di e en kinds o in e es s ha e o be unde s ood and
aken in o accoun . Fo ha pu pose, pe iodic e alua ions could be help ul (c .
Buck e al. 2019, p. 452‒456). Fu he mo e, a egional Heal h Ne wo k Manage
needs o be con incing, o sp ead his o he mo i a ion o he associa ed pa ne s.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
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Heal h Ne wo k Manage . Howe e , hese a e no speci ically ailo ed o his p o-
ession. A po en ial employe is he public heal h depa men . I is impo an ha
he employe is a neu al body. In his way, collisions o in e es s and sensi i i ies
can be a oided. The adminis a ion o a heal h egion should be in public hands.
Acco ding o EXP_2, egional heal h manage s make a e y aluable con ibu ion
o he heal hca e o he popula ion. Complex in luencing ac o s a ise. This is also
no iceable in poli ics. Acco ding o he esponden , he communica ion o local
poli ics imp o es. The pa icipan s coo dina e hei ac ions be e and can he e-
o e ac mo e e ec i ely.
In Ba a ia, egional Heal h Ne wo k Manage s used s anda d o ice p og amme
a he ime he in e iew was conduc ed. Acco ding o EXP_2, o he p og ammes
would be use ul. These include digi al ools o communica ion, budge manage-
men , documen a ion and moni o ing. Fu he mo e, a ool o success ul public
ela ions would be use ul.
3.3.3 In e iew Lowe Saxony
The in e iew on he ede al s a e o Lowe Saxony was conduc ed wi h subjec
EXP_3. The ede al s a e has an a ea o 47 710 km2 (c . S a is a 2020) and a
popula ion o 8 027 031 (2021; c . Landesam ü S a is ik Niede sachsen 2023).
His in o ma ion e e s mainly o he ci y o B aunschweig. The esponden a es
he heal hca e sys em a he egional le el wi h a 7‒8. In B aunschweig, he spe-
cial needs o mig an s a e add essed. These can be di icul o mee h ough con-
en ional sys ems. Fo his eason, an in e cul u al se ice cen e was se up in
B aunschweig ha deals speci ically wi h heal h educa ion and aims o be a sup-
po o mig an s. The esponden a es he a ea o heal h p omo ion and p e en-
ion as 8‒9. The ci y o B aunschweig has good addic ion p e en ion p o-
g ammes. In gene al, EXP_3 conside s he a ea o heal h p omo ion and p e en-
ion unde de eloped and unde inanced. The la e applies especially o he sus-
ainabili y and e alua ion o p ojec s. Resou ces o heal hca e a e su icien ly
a ailable, especially o doc o s and hospi als. Howe e , nu sing ca e is ch oni-
cally unde inanced. A u he p oblem is ha acqui ing esou ces equi es a e y
high le el o human esou ces, which in u n equi es inancial esou ces.
Acco ding o EXP_3, he cen al challenge in he de elopmen o a heal h egion
lies p ima ily in he loca ion o he manage . A posi ion close o he depa men is
ecommended. This can inc ease he impac o he ini ia i es. The co e asks o
he egional Heal h Ne wo k Manage a e bo h scien i ic and coo dina ing.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
23
• Scien i ic asks: o mula ion o objec i es, e alua ion
• Coo dina i e asks: p ojec managemen
Acco ding o EXP_3, he egional Heal h Ne wo k Manage should deal wi h mid-
wi e y ca e and men al heal h o he popula ion in B aunschweig in pa icula and
Lowe Saxony in gene al. Especially in Lowe Saxony, he e a e e y long wai ing
imes o pa ien s in need o medical ea men . Heal h in old age and child heal h
a e also impo an opics. Especially he las phase o li e in a hospice needs mo e
a en ion.
Once he heal h egion has been es ablished, di e en challenges may a ise o
he egional Heal h Ne wo k Manage . The manage mus always keep up o da e
wi h he la es scien i ic indings. To do his, i is impo an ha he o she can
access scien i ic li e a u e quickly and independen ly. He o she mus also de-
elop an unde s anding o he in e es s o he s akeholde s. In o de o ini ia e
and implemen p ojec s, he manage needs knowledge in und- aising.
Responden EXP_3 names playe s om he heal hca e sys em as impo an pa -
icipan s in a heal h egion. This includes all hose om he heal hca e sec o and
he p e en ion chain. The ollowing people in ol ed should be emphasized: ou -
pa ien and inpa ien doc o s, nu sing home di ec o s, nu sing se ice p o ide s,
heal h educa ion p o ide s (e. g. adul educa ion cen e), sel -help g oups.
The equi ed compe ences o a egional Heal h Ne wo k Manage can be ca e-
go ized in o oca ional aining and pe sonal cha ac e is ics.
• Voca ional aining: p ima y educa ion, basic public heal h s udies,
knowledge o g oup dynamics
• Pe sonal quali ies: open diploma ic communica ion, en husiasm, pe -
suasi eness, pe suasi e powe , diploma ic equipmen
Regional Heal h Ne wo k Manage s should add ess physical, social, men al, spi -
i ual, emo ional and sexual heal h dimensions. I is impo an o know and con-
side he espec i e needs o he coho s. This means li elong lea ning and egu-
la sel - e lec ion. Holis ic o e s should be c ea ed.
As a p e equisi e o aining as a egional Heal h Ne wo k Manage , EXP_3 ec-
ommends a deg ee p og amme. In his p og amme, comp ehensi e skills o an-
aly ical, demiological and e alua ion skills should be acqui ed. In addi ion,
knowledge o managemen p ac ices should be augh . A high p opo ion o sel -
lea ning p ocesses and p ac ical expe ience a e also desi able. Acco ding o
EXP_3, educa ional p og ammes o egional Heal h Ne wo k Manage s al eady
exis . Howe e , hese a e no speci ically ailo ed o he needs o his p o essional
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
24
g oup. The local au ho i y is esponsible o hi ing a egional Heal h Ne wo k Man-
age . He e i needs a neu al employe wi h neu al in e es s. The adminis a ion
o heal h egions should be in public hands, as o he wise con lic s o in e es
could impend. Coun y-speci ic law should be applied and new laws a e neces-
sa y in o de o achie e cu en goals.
A he ime o he in e iew, egional Heal h Ne wo k Manage s used s anda d
o ice p og ammes. In some cases, SPSS, a p og amme o da a p ocessing, was
used. Speci ic p og ammes o he heal h o ice we e also used. Digi al ools ha
acili a e non-pe sonal communica ion would be desi able.
3.3.4 In e iew No h Rhine-Wes phalia
The in e iew wi h subjec EXP_4 was conduc ed abou he ede al s a e o No h
Rhine-Wes phalia. This ede al s a e has an a ea o 34 112 km2 (c . S a is a
2020) and a popula ion o 18 077 762 (s a us 2022, c . Landesam In o ma ion
und Technik No d hein-Wes alen 2023). The expe a es he heal hca e sys em
a he egional le el a 8.7. The e is a wide ange o se ices. Howe e , he
heal hca e sys em a he egional le el is un ai o ulne able g oups. The sys em
is con using bo h o pa ien s and o hose esponsible. He a es heal h p omo-
ion and p e en ion a he egional le el wi h 5.5. He e oo, ulne able g oups a e
pa icula ly a ec ed. They ha e p oblems accessing he se ices because hey
a e some imes less able o asse hemsel es and a icula e hei iews. In some
cases, hey do no ecognize hei needs. These g oups include coho s wi h low
sala ies and o en people wi h a mig a o y backg ound. Thei needs a e no su -
icien ly add essed because he e is no pa ien -o ien ed app oach o ulne able
g oups. In addi ion, he e is nei he a p e en i e pa ien o ien a ion no an in e-
g a ed app oach. Ano he p oblem in he heal hca e sys em a e he esou ces, o
which he e a e oo ew. In addi ion, he expe c i icises ha he a ailable e-
sou ces a e no used app op ia ely.
The cen al challenges lie mainly in he managemen o he ne wo k. The egional
Heal h Ne wo k Manage mus acili a e coope a ion be ween he ne wo k and
he unding agencies. The di icul y also lies in he coope a ion o e y di e se
playe s. The manage mus p o ide o ien a ion o hose in ol ed and mo i a e
hem o wo k well oge he in he long e m. A u he challenge lies in iden i ying
egional heal h p oblems. To do his, he egional Heal h Ne wo k Manage mus
c ea e p og ammes ha a e pa ien - and a ge g oup-o ien ed. The co e asks o
he egional Heal h Ne wo k Manage include adminis a i e and p ac ical asks.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
25
• Adminis a i e asks: c ea ion o a pla o m o di e en playe s (a place
o he exchange o mo i es and in e es s), moni o ing
• P ac ical asks: p o ision o design pe spec i es
Regional Heal h Ne wo k Manage s in No h Rhine-Wes phalia should add ess a
wide a ie y o issues. These include p e en ion, he needs o ulne able g oups
and he in eg a ion o pa ien -o ien ed ca e s uc u es. In addi ion, he po en ial o
digi iza ion should be used. In o de o s eng hen he heal hca e sys em, mo e
a en ion mus be paid o he ini ial and u he educa ion o skilled wo ke s. In his
way, he supply o skilled wo ke s can be ensu ed.
Challenges can also a ise a e heal h egions ha e been es ablished. These in-
clude social communica ion, poli ical bu eauc acy and poli ical democ acy. The
egional Heal h Ne wo k Manage mus unde s and he subsidy sys em. A heal h
egion consis s o a wide a ie y o playe s. Thei indi idual aims mus be aken
in o accoun . EXP_4 ecommends he inclusion o he ollowing g oups.
• Economy: public, p i a e, elec ical enginee ing, cybe secu i y
• Heal hca e: se ice p o ide s, supply p o ide s
• Poli ics: municipali ies, landscape associa ion, dis ic go e nmen s
• Science: no men ion o in-dep h compe ences
The egional Heal h Ne wo k Manage needs pe sonal skills and p o essional
knowledge o a success ul managemen o heal h egions.
• Pe sonal skills: in insic mo i a ion, sense o ac ion
• P o essional knowledge: unde s anding o heal h science issues, in e -
disciplina y knowledge, knowledge o business adminis a ion,
knowledge o digi iza ion, unde s anding o li e sciences
The egional Heal h Ne wo k Manage should pay special a en ion o he popu-
la ion’s heal h- ela ed sel -consciousness, heal h o ien a ion and ulne able
g oups.
Responden EXP_4 ecommends he comple ion o a mas e ’s deg ee o doc o -
a e in he ield o social science, o ganiza ion science o inno a ion science. P ac-
ical expe ience could also be use ul. The esponden epo s on a aining p o-
g amme o egional Heal h Ne wo k Manage s. Bu he p og amme was no pos-
i i ely accep ed because o i s unp o essional o ganiza ion.
Po en ial employe s a e ci ies and municipali ies. In addi ion, he e a e employ-
men oppo uni ies in heal h managemen , a chambe s o comme ce and heal h
insu ance companies. The adminis a ion o heal h egions should be egula ed
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
26
by ci il se ices. Financing could be based on membe ship ees. Responden
EXP_4 es ima es ha he wo k o a egional Heal h Ne wo k Manage could ig-
ge o wa d o ien a ion and help o imp o e he heal h sys em, heal h p oduc s
and heal h se ices.
Acco ding o subjec EXP_4, egional Heal h Ne wo k Manage s use common
o ice p og ammes.
3.3.5 In e iew Saa land
The in e iew wi h subjec EXP_5 was conduc ed abou he si ua ion in he ed-
e al s a e o Saa land. The ede al s a e has an a ea o 2572 km2 (c . S a is a
2020) and a popula ion o 993 000 (s a us 2022; c . S a is a 2023). The espond-
en a es he heal hca e sys em in Saa land wi h a 7‒8. Due o he small size o
Saa land, communica ion in he heal hca e sys em is e y good. Heal h p omo-
ion and p e en ion, which is pa icula ly impo an o school child en and he
elde ly popula ion, is a ed wi h a 6. The inancial and human esou ces in Saa -
land a e also excellen . The e is a pa ial o e capaci y o hese esou ces. This
mainly a ec s hospi als. Responden EXP_5 ecommends ewe clinics and a-
he specialized clinics ins ead o many small ones. The e is a lack o amily doc-
o s in Saa land. The ede al s a e go e nmen al eady eac s o he lack o amily
doc o s by suppo ing medical s uden s inancially, who commi o emain in Saa -
land a e inishing uni e si y. The e is a good in as uc u e in he heal h egion
Saa land. Howe e , wai ing imes o specialized doc o s’ appoin men s can be
long.
One o he cen al challenges in he de elopmen o a heal h egion is o ind
comp omises be ween he indi idual playe s. Di e en in e es s mus be consid-
e ed and nego ia ed and poli icians should be in ol ed. The co e ask o a e-
gional Heal h Ne wo k Manage is linking he heal h sec o . To do his, he o she
needs comp ehensi e knowledge o he heal h sys em and an open mind. Re-
gional Heal h Ne wo k Manage s should pay pa icula a en ion o he na u e o
he a ge g oup. Acco ding o EXP_5, he manage does no ca y ou his o he
own p ojec s, bu delega es hem as much as possible. One o he challenges
a e building up he heal h egion is ha he manage has o keep up o da e wi h
he la es de elopmen s in heal hca e. Fo his he can consul he p ess o ins i-
u ions.
Responden EXP_5 ecommends coope a ion wi h s akeholde s om he
heal hca e sys em, poli ics and economy. These include:
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
27
• Heal hca e: hospi al owne s, heal h insu ance companies, hose wo k-
ing in he medical p o ession, medical associa ions, nu sing council, as-
socia ions o panel doc o s
• Poli ics: s a e go e nmen s
• Economy: indus y
Fo success ul wo k as a egional Heal h Ne wo k Manage , p o essional and
pe sonal knowledge is equi ed.
• P o essional knowledge: basic medical knowledge, basic economic
knowledge
• Pe sonal cha ac e is ics: social compe ence
Subjec EXP_5 hopes ha egional Heal h Ne wo k Manage s will imp o e he
image o he heal hca e sys em. He ecommends he egula examina ion o cu -
en esea ch indings and he in ensi e s udy o he opic o nu i ion.
On he one hand, EXP_5 conside s a deg ee cou se o be a p e equisi e o ain-
ing as a egional Heal h Ne wo k Manage . Howe e , he emphasizes ha pe -
sonali y is mo e impo an . The esponden s a es ha he e is cu en ly no ain-
ing p og amme o egional Heal h Ne wo k Manage s. A po en ial employe is
he municipali y. Howe e , a he ime o he su ey, he municipali y is no e-
c ui ing egional Heal h Ne wo k Manage s in he Saa land. Heal h egions
should be p i a ely adminis e ed. Cu en ly, he esponden conside s egional
Heal h Ne wo k Manage s o be well-in eg a ed in o he heal hca e sys em.
The esponden EXP_5 s a es ha he e is no use o speci ic so wa e in heal h
egions in Saa land.
3.3.6 Summa y o he In e iews
In o al, i e in e iews we e conduc ed wi h ep esen a i es o heal h science,
heal h o ganiza ions and heal h egions. Di e se and in e es ing in o ma ion
abou he managemen o heal h egions is he esul . The ocus is on he ede al
s a es o Lowe Saxony, No h Rhine-Wes phalia, Hesse, Rhineland-Pala ina e,
Ba a ia and Saa land.
The in e iews show ha he e a e access ba ie s o pa ien s in he Ge man
heal h sys em. On he one hand, hese a e based on p oblems wi h he in as uc-
u e, especially in u al a eas. On he o he hand, access ba ie s a ise o ul-
ne able g oups. These a ise especially o people wi h a mig a o y backg ound
due o language p oblems and he unde s anding o hei own heal h. The
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
28
con en ional sys ems o add essing pa ien s a e o en o li le use he e. How-
e e , many clinics a e showing app oaches o sol ing language- ela ed p oblems
and deploy mul ilingual s a . The sec o al sepa a ion in he heal hca e sys em is
desc ibed as e y p onounced. A his poin , success ul managemen o heal h
egions could imp o e he ca e o he popula ion. Heal h p omo ion and p e en-
ion a e pa ly unde inanced. Ca e in pa icula is ch onically unde inanced.
The esponden s ecommend he inclusion o people in ol ed in he heal hca e
sys em, business, poli ics, science and socie y in egional heal h ne wo ks. The
success ul de elopmen o a heal h egion can be p omo ed by iden i ying cen al
p oblems and c ea ing awa eness o hese ci cums ances. This ep esen s one
o he g ea es challenges and ce ainly claims many esou ces. Ano he di icul y
is he coope a ion wi h s akeholde s om di e en a eas.
The ollowing o e iew shows he iden i ied compe ences o a egional Heal h
Ne wo k Manage .
Table 4: Compe ences o a Regional Heal h Ne wo k Manage
P o essional Knowledge o digi aliza ion, basic knowledge o IT, knowledge
o business adminis a ion
Heal h communica ion, basic pedagogical aining in dealing
wi h pa ien s and ela i es, basic medical knowledge, unde -
s anding o heal h science issues
Fund aising, legal aspec s (especially da a p o ec ion),
knowledge o g oup dynamics
Scien i ic Knowledge in public heal h, independen and s uc u ed wo k
P ac ical P ac ical wo k expe ience, ne wo k expansion, public ela ions,
p ojec managemen , ime managemen
Pe sonal Empa hy, social compe ence, open diploma ic communica ion
En husiasm, pe suasi eness, us a ion ole ance, in insic mo-
i a ion
Asse i eness, p esen a ion and media ion skills, sense o ac-
ion
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
29
The es pe sons ecommend a gene alis educa ion ha includes adminis a i e
and echnical knowledge as well as managemen con en . T aining oppo uni ies
o egional Heal h Ne wo k Manage s al eady exis Bu hese a e no speci ically
de eloped o his p o essional g oup. A egional Heal h Ne wo k Manage mus
cons an ly educa e and e lec him- o he sel .
When c ea ing he pos o a egional Heal h Ne wo k Manage , i is impo an o
ensu e ha he o she wo ks o a neu al ins i u ion. A po en ial employe is, o
example, he public heal h depa men .
The es pe sons show in e es in he de elopmen o a so wa e ha suppo s
egional Heal h Ne wo k Manage s. I is ecommended o build on exis ing s uc-
u es. Tools o communica ion, budge managemen , documen a ion and moni-
o ing would be help ul o u u e egional Heal h Ne wo k Manage s.
3.4 Discussion and Conclusion
3.4.1 S eng hs and Weaknesses o he Resea ch Me hods
Due o he lack o a consis en job desc ip ion o a egional Heal h Ne wo k Man-
age , i is di icul o ind esea ch li e a u e on he equi ed compe ences and
skills. Du ing he li e a u e esea ch i became clea ha he publica ions conce n-
ing egional heal h ne wo ks a e mos ly g ey li e a u e o poli ical con ibu ions.
Howe e , he p ac ical ele ance o hese con ibu ions also o e s a eal insigh
in o he ac i i ies o a egional Heal h Ne wo k Manage . Due o he COVID-19
pandemic, i was di icul o conduc he in e iews in a consis en manne . This
is due o dis ancing ules and a ious ins i u e-speci ic ules ega ding he use o
ideo con e encing.
3.4.2 Summa y o he Resul s
The esea ch ques ions ega ding he ci cums ances, s uc u es, challenges and
compe ences o a egional Heal h Ne wo k Manage in Ge many could be an-
swe ed comp ehensi ely. The esul s o he li e a u e e iew and he expe in-
e iews show simila ends wi h ega d o he Ge man heal hca e sys em and
egional Heal h Ne wo k Manage s. Bo h me hods desc ibe he s ong sec o al
sepa a ion in he heal hca e sys em. This can lead o poo e pa ien ca e. The
di icul ies o u al heal hca e a e also de ined as challenging. The cu en na-
ional heal h goals o “g owing up in a heal hy way” and “g owing olde in a heal hy
way” a e e lec ed in he expe s’ esponses o he su ey o ele an opics in
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
30
heal h egions. The esea ch me hods e ealed ha he e is no consis en admin-
is a i e s a egy o heal h egions. Bo h he li e a u e esea ch and he in e -
iews show ha he e is nei he a uni o m de ini ion no a cu iculum o egional
Heal h Ne wo k Manage s in Ge many. Coope a ion wi h all playe s in he heal h
sec o is ecommended: heal h, economy, poli ics, science and socie y. The li e -
a u e esea ch and in e iews esul in asks ha can be assigned o he a eas o
in as uc u e, media ion, p omo ion and go e nance. The egional Heal h Ne -
wo k Manage needs e sa ile compe ences. These a e ound in he li e a u e
esea ch only as a ma ginal opic. In con as , he expe in e iews p o ide a
comp ehensi e pic u e o he equi ed compe ences. These can be classi ied as
p o essional, scien i ic, p ac ical and pe sonal compe ences. These include em-
pa hy, open diploma ic communica ion and in insic mo i a ion. Pa icula ly he
pe sonal au ho i y o a egional Heal h Ne wo k Manage is de ined in de ail.
Fo he de elopmen o a so wa e o he managemen o heal h egions, a con-
sis en s a egy as well as compliance wi h da a p o ec ion is ecommended as
pa icula ly impo an . The in e iews e ealed ha ools o suppo budge man-
agemen , documen a ion and moni o ing would be use ul.
3.5 Recommenda ions o S akeholde s and Policy Make s
The ollowing ecommenda ions e e o s akeholde s and poli ical decision mak-
e s:
• Inc ease o inancial esou ces o human esou ces in he managemen
o heal h egions
• Obse ance o coun y- and s a e-speci ic law in he de elopmen o
heal h egions
• Long- e m legal es ablishmen o manage s o heal h egions
• Employmen o egional Heal h Ne wo k Manage s in he uppe and
highe se ice
• Clea de ini ion o he e m Public Heal h
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
31
3.6 Recommenda ions o Regional Heal h Ne wo k Manage s in Ge -
many
Fo egional Heal h Ne wo k Manage s in Ge many, he ollowing ecommenda-
ions apply:
• Iden i ica ion o key p oblems in he egion, aking in o accoun heal h
epo ing and egional heal h indica o s
• A en ion o he needs o ulne able g oups
• A endance o heal h cong esses o es ablish new con ac s
• S ong public ela ions wo k abou posi i e wo k in he heal h egion
• In ol emen o poli ics o inc ease he es ablishmen o heal h-p omo -
ing s uc u es and amewo k condi ions
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
38
Kollányi, Z. / Ho á h, G. / Mo ia, M. / Amo , F. / Todo o ska, N. / Yo dano , H. /
Il sche , V. (2021): Compe ences in he Managemen o Heal h Regions:
Hunga y, Bulga ia, Aus ia. In: Eu opean Jou nal o Public Heal h, Vol. 2021,
No. 31. h ps://academic.oup.com/eu pub/a icle/31/Supplemen _3/ckab16
4.774/6405275? bclid=IwAR1R12mGeLyT7 MagWIp-6h qNNnV2OsGTW
yF iaV7XWL4nkyshyLWLyoA&login= ue.
Mache , S. / Amo , F. / Beh ens, Y. / Mo ia, M. (2022): Kompe enzp o ile on
Gesundhei sne zwe ks-Manage *innen. In: Ös e eichische Gesellscha ü
Public Heal h (ed.): ÖGPH-Newsle e Sep embe 2022.
Mo ia, M. / Amo , F. (2021): Iden i ica ion o Compe ences in Regional Heal h
Ne wo k Managemen . In: Eu opean Jou nal o Public Heal h, Vol. 2021,
No. 31. h ps://doi.o g/10.1093/eu pub/ckab164.773.
Romaniuk, P. / Beh ens, Y. / Mo ales, I. / Kaczma ek, K. / Cassens, M. /
Rod íguez López, C. (2021): Compe ences in he Managemen o Heal h
Regions: Ge many, Poland and Spain. In: Eu opean Jou nal o Public
Heal h, Vol. 2021, No. 31. h ps://doi.o g/10.1093/eu pub/ckab164.775.
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
39
Appendix
In e iew Guideline: Compe ences in Heal h Ne wo k Managemen
Me ada a
In e iew code
In e iewe
Da e
Time
In e iew du a ion
In e iew me hod Semi-s uc u ed in e iew:
Face- o- ace
Via Telephone
P elimina y Rema ks/In oduc ion
Hello, my name is _____________, I wo k a _____________ and I am in ol ed
in he E asmus + p ojec called “Compe ences in Heal h Ne wo k Managemen ”.
In his con ex , I ha e a ew ques ions o you and would be happy i you ha e
app ox. 20 minu es o answe hem. In o ma ion ga he ed h ough his in e iew
is e y impo an o he u he cou se o he p esen p ojec !
The in e iew is p ocessed anonymously, he s a emen s a e no assigned by
name o he indi idual in e iew pa ne s, only s uc u ed and summa ized. These
esul s should se e o c ea e a compe ence p o ile o egional heal h manage s
in [COUNTRY/ REGION].
Heal h egions o en desc ibe hemsel es as geog aphically de ined clus-
e s ha aim o ensu e a coo dina ed heal h and social ca e o he popu-
la ion h ough a ne wo k o all s akeholde s in ol ed in he supply p o-
cess. [Fo mo e in o ma ion see In o shee ]
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
40
Do you ag ee ha his con e sa ion will be eco ded?
O Yes O No
Do you ha e any gene al ques ions in ad ance?
In o ma ion o he In e iewe :
Addi ional in o ma ion o he in e iewe is p esen ed in i alics.
Pa A: Ques ions abou he in e iewee’s p o essional ac i i ies
1. In which business ield is you company/o ganiza ion ac i e?
2. In which posi ion do you wo k in he company/o ganiza ion?
3. Which asks do you pe o m in you company/o ganiza ion?
Pa B: Regional Assessmen : [COUNTRY/ REGION]
4. Wha do you hink abou he cu en heal hca e sys em a egional le el
in [COUNTRY/REGION]? [P o ision o heal h o e s, o e coming ac-
cess ba ie s, o e s o a ge g oups ha a e di icul o each, ans-
pa ency o he s uc u es in he heal hca e sys em, e c.] Please also
a e on a scale om 1 o 10 (10 = excellen , 1 = e y bad).
5. Wha do you hink abou he opics heal h p omo ion and p e en ion a
egional le el in [COUNTRY/REGION]? [P o ision o heal h o e s,
o e coming access ba ie s, o e s o a ge g oups ha a e di icul o
each e c.] Please also a e on a scale om 1 o 10 (10 = excellen , 0 =
e y bad).
6. Wha do you hink abou he esou ces o heal hca e a he egional
le el in [COUNTRY/REGION]? [in as uc u e, ma e ial esou ces, p o-
jec unds acqui ed, knowledge and in o ma ion, social esou ces]
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
41
Pa C: Assessmen o he Compe ences o Heal h Ne wo k Manage s in
[COUNTRY/ REGION]
7. Wha a e/migh be key challenges and p oblems ( o egional Heal h
Ne wo k Manage s) when de eloping a heal h egion in [COUN-
TRY/REGION]?
8. Which co e asks and co e ac i i ies should Heal h Ne wo k Manag-
e s in [COUNTRY/REGION] ul ill?
[I esponden has di icul ies answe ing he ques ion, gi e examples:
managemen /p ojec managemen , communica ion, social skills,
heal hca e, ca e ...]
9. Wha opics o subjec s should egional heal h manage s in [COUN-
TRY/REGION] deal wi h? [I esponden has di icul ies answe ing he
ques ion, gi e examples: ype o a ge g oups, se ings, beha iou s…]
10. Wha kind o challenges and p oblems a e/may egional Heal h Ne -
wo k Manage s be acing in he cou se o hei wo k?
11. Wi h which o ganiza ions and s akeholde s should egional Heal h
Ne wo k Manage s in [COUNTRY/REGION] wo k/coope a e?
12. Wha compe ences and quali ica ions do egional heal h manage s in
[COUNTRY/REGION] need, o be able o pe o m he co e asks/ac i i-
ies men ioned abo e?
13. Which dimensions o heal h do you hink he wo k o egional Heal h
Ne wo k Manage s in [COUNTRY/REGION] ela es o? [I esponden
has di icul ies answe ing he ques ion, lis dimensions: physical, social,
men al, spi i ual, emo ional, o sexual]
14. Which heal h de e minan s a e impo an in e ms o he wo k as e-
gional Heal h Ne wo k Manage in [COUNTRY/REGION]? [In he sense
o he de e minan model acco ding o Dahlg en & Whi ehead, 1991 ‒ I
he in e iewee has di icul ies answe ing he ques ion, show he model
in p in ed o m.]
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
42
Pa D: Assessmen o T aining and Job o Regional Heal h Manage s in
[COUNTRY/REGION]
15. Wha equi emen s a e needed o comple e a aining as egional
Heal h Ne wo k Manage ?
16. A e he e al eady any educa ion oppo uni ies o Heal h Ne wo k Man-
age s (o equi alen ) in [COUNTRY/REGION]?
17. Which o ganiza ions would be sui able o employ a egional Heal h
Ne wo k Manage in [COUNTRY/REGION]? [e. g. municipali y, p ima y
heal h uni s, sel -employed, e c.]
18. How should egional heal h ne wo ks be adminis e ed in [COUN-
TRY/REGION]? [Publicly o p i a ely inanced? Obliga o y o olun a y?
Should i be egula ed by na ional law? e c.]
19. How impo an a e Heal h Ne wo k Manage s o egional heal hca e in
[COUNTRY/REGION]?
Pa E: Assessmen o So wa e Used in [COUNTRY/REGION]
20. Wha so wa e p oduc s do you use wi hin a heal h egion?
[INFO: Ques ions 21 o 24 should only be answe ed i he esponden
wo ks ac i ely in a heal h egion and has answe ed ha hey use so wa e
p oduc s wi hin a heal h egion in ques ion 20.]
21. Does his p oduc equi e you o en e da a o he heal h egion and i
yes, wha kind o da a?
22. Wha is he impo an in o ma ion ha you ob ain om he so wa e
p oduc ?
23. Does he so wa e p oduc use da a om ex e nal da abases o p o ide
he needed in o ma ion?
24. Wha kind o addi ional in o ma ion ( ha is no cu en ly collec ed and
p ocessed) would be use ul in a heal h egion?
Cla i ying Ques ions
Would you like o add any hing ega ding his opic, which we did no
discuss?
i gs Sch i en eihe, Vol. 29, Beh ens e al.: Managemen o Heal h Regions
43
Demog aphic Da a
- Age: _____
- Gende :
male
emale
di e s
- Place o esidence: ______
- Highes le el o educa ion:
- Compulso y school
Voca ional aining
- A Le el
- Uni e si y
- O he s
Closu e
Thank you e y much o aking he ime o he in e iew! I you ha e any u he
ques ions, please do no hesi a e o con ac me a any ime.
End o he in e iew: _______________
[Swi ch o dic a ion de ice]
Obse a ional p o ocol:
Subjec i e assessmen o he in e iew:
_______________________________________________________________
_______________________________________________________________
P oblems/in e up ions ( .e.: phone call, noise):
_______________________________________________________________
_______________________________________________________________
Fu he commen s:
_____________________________________________________________
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ISSN 2367-3176 (P in ) – ISSN 2569-5274 (eBook)
Band 14 (2019)
Kös e s, Ines
A e ia Danubia ‒ Gesundhei s egionen im Donau aum
ISSN 2367-3176 (P in ) – ISSN 2569-5274 (eBook)
Band 15 (2019)
Lakasz, And ea
Füh ungsaspek e in Uni e si ä skliniken mi besonde em Fokus au ä z liche Mi -
a bei e un e schiedliche Gene a ionen
ISSN 2367-3176 (P in ) – ISSN 2569-5274 (eBook)
Band 16 (2019)
Wangle , Julian / Jansky, Michael / Heidl, Ch is ian / Mülle , Sebas ian / Heckel,
Na alie / Ze h, Jü gen
Bei äge zu Gesundhei swissenscha en und -managemen II
ISSN 2367-3176 (P in ) – ISSN 2569-5274 (eBook)
Band 17 (2019)
Fische , Philipp
Digi al Heal h – Un e suchung zu Akzep anz de elek onischen Gesundhei s-
da enspeiche ung in Fo m de elek onischen Pa ien enak e (ePA) in Deu schland
ISSN 2367-3176 (P in ) – ISSN 2569-5274 (eBook)
Band 18 (2020)
B aue , Y onne
Re ospek i e S udie zu E mi lung de Risiko ak o en ü eine s a ionä e Wie-
de au nahme nach allogene S ammzell ansplan a ion
ISBN (P in ) 978-3-89275-135-9 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-136-6 – ISSN (eBook) 2569-5274
Band 19 (2020)
Schäd ich, Ka in
Mind ul Leade ship: Wi ksamkei appbasie e Ku zmedi a ionen au die Ach -
samkei bei Füh ungsk ä en.
ISBN (P in ) 978-3-89275-123-6 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-124-3 – ISSN (eBook) 2569-5274
Band 20 (2020)
Beh ens, Y onne / Ge emek, Ma iusz / Scha eno h, Ka in
Eu ope’s Heal h Sys em – P esen a ion o he heal h sys ems o Bulga ia, Poland
and Ge many
ISBN (P in ) 978-3-89275-137-3 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-138-0 – ISSN (eBook) 2569-5274
Band 21 (2020)
K ause, Rabea
Beda sge ech e Ve so gung on neu omuskulä e k ank en Menschen nach
dem neuen P legebedü igkei sbeg i : Eine explo a i e Un e suchung de An o -
de ungen
ISBN (P in ) 978-3-89275-152-6 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-153-3 – ISSN (eBook) 2569-5274
Band 22 (2021)
Koko z, Ca olin / Tewes, S e an
Pe sona ypologien im Gesundhei swesen: Lösungsansa z ü op imie e Kun-
denzu iedenhei
ISBN (P in ) 978-3-89275-170-0 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-171-7 – ISSN (eBook) 2569-5274
Band 23 (2021)
Geige , Inke / Geißle , Jens
Digi ale T ans o ma ion de gese zlichen K anken e siche ung. IT-S a egie,
S eue ung und Sou cing als s a egische und ope a i e He aus o de ungen
ISBN (P in ) 978-3-89275-182-3 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-183-0 – ISSN (eBook) 2569-527
Band 24 (2021)
Elsenheime , Lau a / Beh ens, Y onne / Wiesene , Ma c / Kan e mann, Thomas
Resea ch Ne wo k In e na ional: Von Wissenscha , Ve ne zung und Emo ionen
ISBN (P in ) 978-3-89275-230-1 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-231-8 – ISSN (eBook) 2569-5274
Band 25 (2022)
Schä e , S e anie / Scha , A nd
Nachhal iges be iebliches Gesundhei smanagemen im Handwe k
ISBN (P in ) 978-3-89275-246-2 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-247-9 – ISSN (eBook) 2569-5274
Band 26 (2022)
Hein, Ka ha ina Anna-Ch is ina
Selbs bes imm es S e ben – Au onomie und Menschenwü de am Lebensende
ISBN (P in ) 978-3-89275-258-5 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-259-2 – ISSN (eBook) 2569-5274
