Abstracts by key term: DRG system
The empirically based simulation model proposed here, which equally considers accessibility, patient preference, and capacity, offers, against the backdrop of the state's duty of care and the obligation to use resources economically, a scientific way of relating the importance of care to the need for hospital locations per service group. The simulation model is intended to support hospital planning (here: the allocation of service groups) by the federal states and to create guidelines for rational planning. It is also suitable for the management of financial resources within the framework of hospital reform. It enables impact analysis and does not intend to automate or otherwise impose rigid specifications. The calculations are to be viewed as examples. The weightings of all parameters are variable. However, the accessibility limits and the parameterization of the simulation model should be determined jointly by the federal and state governments in the spirit of a common target vision.
03.06.2024
Since 2003, hospital services have been reimbursed through the case-volume-dependent, flat-rate reimbursement system of the G-DRG (German Diagnosis Related Groups) (Section 17b (1) Sentence 1 KHG/Reimbursement Institute 2023). Diagnosis, severity of the illness, and the operations and procedures performed, along with other parameters if applicable, are entered into the patient classification system for grouping (Reimbursement Institute 2023). Although other countries, such as the United Kingdom, Finland, and the Netherlands, also use DRG systems, Germany has a strong performance and volume incentive compared to other countries1. Despite the additional refinancing of nursing care through the nursing budget introduced in 2020 (Reimbursement Institute 2023), there is no case-volume-independent refinancing of necessary provision (Federal Ministry of Health 2023).
04.12.2023
The medical care for patients in Germany is undisputedly one of the best in the world, and this particularly applies to the care in hospitals. However, since the introduction of the flat-rate payment system, a steady increase in the number of cases has been observed, which has now led to a critical intensification of work in hospitals. The precarious current situation is exacerbated by a reduction in personnel, partly caused by a shortage of skilled workers, partly for cost reasons, particularly in nursing, as well as by other circumstances that originated long before the introduction of the DRG system. These consist, on the one hand, in the state-side deficit in financing investment costs, which has been increasing for decades, as well as in the historically grown structural deficits in the hospital landscape - which not only means the high hospital density in Germany compared to international standards, but also, in particular, the relevant regional differences when compared within Germany (1).