What Medical Students Know about their Health Care System

Aim: In 10/2003, the new approbation regulation (AAppO) for physicians became effective and introduced a new cross sectional subject named, health economcis, health care system, public "health". The subject intends to convey basic principles of the regulatory framework of the german health care system. Diverse institutes assumed responsibility for the new lectureship. The aim of the study is to analyze lecture-and learn-achievements and to compare the results of two universities in central Hesse. Methods: A before-after design was conducted. Measurements were taken at the beginning (T0) and at the end (T1) of the summer semester 2008. Medical students of the 9 - 10th semester from the universities of Marburg (MR) and GieBen (GI) were included. The sample frame was n = 180 in Marburg and n = 148 in GieBen. The questionnaire, Erlanger Lehr-und Studenten-Monitor zur Gesundheitsokonomie (ELSMoG)" contains 45 Items and measures achieved knowledge related to pharmaceuticals, out-and inpatient care as well as particular items regarding private and statutory health insurances. Item-and index analysis were performed by pooled and university specific assessments. Results: The response rates for T0 and T1 were 67 % (n = 223) and 87.2 % (n = 286). Substantial increase of knowledge was detected. Salient gaps in knowledge domains of private insurance providers as well as outpatient care were identified. Knowledge differences between universities were identified. A high averaged proportion of 23 % of the students preferred not to answer. Conclusion: The study deems to be representative for medical students in the 9 - 10th semester of the universities of Marburg and GieBen. Results yield evidence for a substantial increase of knowledge related to the German health care system. Cause and effect relations for the quality of teaching and learning cannot be drawn and the measurement instrument should be actualized for future studies. The heterogeneous research priorities of the numerous institutesmay be responsible for the different levels of knowledge and differences between universities. This is acceptable as long as a minimum of the extensive subject catalogue with its learning objectives of the German Society of Social Medicine and Prevention (DGSMP) of the year 2002 remains fulfilled.