Establishing the need for medical rehabilitation services among the gainfully employed members of statutory pension funds - A suggestion under sociomedical and sociolegal aspects

Assessing health care needs in populations has become a major activity of p ublic health medicine worldwide. Its methodology has been developing mainly in the English-speaking world. Concept, methods, and techniques have not y et reached Germany though recently the national expert advisory council for the concerted action in health care (Sachverstandigenrat fur die Konzertie rte Aktion im Gesundheitswesen) provided first "official" definitions of de mand, supply, and need to identify over- and undersupply in health care. Th is article aims at defining, from a combined sociolegal and sociomedical pe rspective, the need for medical rehabilitation measures among insurees of G erman pension funds. According to 15 SGB VI rehabilitation is conceived as a medically coordinated multimodal-multidisciplinary intervention with a co gnitive-behavioural orientation. To objectify the need for rehabilitation a series of 9 questions was developed enquiring inter alia about the presenc e of a disease or disability, the extent or "amplification" of the disorder , its course pattern, the implied risk of permanent work disability and lik ely success of rehabilitation. Nonspecific back pain served as a paradigmat ic condition. One of the main problems encountered is the presently small e vidence base to arrive at the necessary prognostic and therapeutic judgemen ts.