No evidence of bed manipulation in intensive care units
15.08.2023 16:22
Hospitals received aid payments during the second and third Corona waves in Germany when intensive care bed occupancy was high. Among other things, the Federal Audit Office had raised suspicions that hospitals could have manipulated the number of reported intensive care beds in order to receive such aid payments. However, as a current study by ZEW Mannheim shows, there is no empirical evidence of this: neither the distribution of reported free capacities nor their development over time show any significant anomalies.
The decline in intensive care bed capacity during the second and third Corona waves in Germany was therefore more likely due to direct consequences of the disease burden than to manipulated reports. “The claim that hospitals strategically reported their bed capacity in order to receive additional aid payments cannot be empirically proven,” said Dr. Simon Reif, head of the “Health Markets and Health Policy” research group at ZEW and co-author of the study. The ZEW scientists examined how hospitals responded to aid payments from the federal government during the second and third corona waves from November 2020 to April 2021. One criterion for aid payments was an intensive care bed occupancy rate of over 75 percent in a city or district - a key figure that hospitals could directly influence. Such an influence on the reported capacities was suggested by the Federal Audit Office, among others.
Aid payments have saved hospitals from insolvency
At the beginning of 2020, the German healthcare system was unexpectedly hit by the corona pandemic. Since hospitals in Germany are paid by health insurance companies per case, the pandemic presented hospitals with a difficult financial situation. On the one hand, sick people canceled planned treatments for fear of infection, which led to fewer cases. On the other hand, hospitals should keep capacity free in order to be able to care for the high expected number of Covid-19 cases. Without government intervention, the decline in revenue associated with the lower number of cases could have led to hospitals becoming insolvent. In order to alleviate these financial difficulties, the government launched aid programs for hospitals.
No abnormalities in reported bed capacities
In addition to the free bed capacity, aid payments from the federal government were also linked to the exceeding of corona incidence figures. “If the reduction in free intensive care bed capacity were a reaction to get above the occupancy limit for Corona aid payments, then the decline in free beds would have to have happened more strongly when the Corona incidence was above the limit. However, there is no significant change in the number of reported free beds. Just as there were no noticeable clusters in the distribution of bed capacities that would suggest manipulation,” explains Sabrina Schubert, ZEW economist in the “Health Markets and Health Policy” research group and co-author of the study. The results suggest that the shortage of intensive care capacity during the second and third corona waves was a direct consequence of the disease burden and not strategic messages. The ZEW study analyzed publicly available data from various sources for the first time. This includes incidence data from the Robert Koch Institute (RKI), data from the intensive care register of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and hospital information from the hospital statistics of the federal and state statistical offices.
Data access for science must be improved
However, due to limited access to data, the ZEW study cannot rule out the possibility that manipulated reports actually occurred in individual cases. “For many analyzes of the German healthcare system, there is a lack of comprehensive data access and the possibility of data linkage for science,” says Dr. Simon Reif. “Not only during and after exceptional situations such as the corona pandemic, but also for the further development of the health system in general, we need a better understanding of health care, which is difficult to achieve with the currently very limited data.”