Abstracts by key term: Quality
Hospitals in Germany are often accused of over-provision and inadequate care due to unnecessary services and redundant locations. Drivers of this assumption are issues such as outpatient care and centralization. However, under-provision, which can result not only from a lack of capacity but also from a lack of competition between locations, is rarely considered. Competition for the best outcomes, however, would be a strong driver of high-quality healthcare. Data from the Federal Hospital Atlas were used to examine competition for typical treatment needs, the possibility of escalating emergency levels, and regional alternatives for special needs. For this purpose, a radius of 20, 30, and 50 kilometers was created around each location. For almost 30% of all treatment needs, a location lacked a competitor. This revealed strong regional differences between densely populated regions such as Berlin, Hamburg, and North Rhine-Westphalia, with almost consistent competition, and eastern, remote states, with a predominance of locations without alternative providers. An escalation of the emergency level would have been possible for more than 90% (from 1 to 2 or 3) or almost 80% (from 2 to 3) of the locations, provided the treatment situation had required it. Co-provision by neighboring states was particularly relevant for emergencies in Rhineland-Palatinate and Schleswig-Holstein (with escalation from 2 to 3). Alternative locations for certified facilities were predominantly found. However, the proportion of locations without competition in oncology depended heavily on the entity, being low for breast and colorectal cancer and high for stomach and bladder cancer. Overall, the results show that in Germany, neither regional aspects nor treatment reasons are equivalent living conditions in healthcare, especially when considering competition for quality. The discussion on eliminating potential over-provision and misprovision of inpatient services must therefore urgently be supplemented by the aspect of building additional capacity to compensate for undersupply.
04.08.2025
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
Patient safety in healthcare has increasingly become the focus of global attention. It is defined as the "avoidance, prevention, and improvement of adverse events or injuries resulting from healthcare processes" (Campbell et al., 2020). At the 74th World Health Assembly (2021), the World Health Organization (WHO) presented a global action plan to prevent health threats and harm to patients arising from healthcare (World Health Organization, 2021). Strategic Goal 4 of this action plan explicitly calls for active patient involvement (PD) in the further development of healthcare. Given the continued significant number of preventable adverse events in medical healthcare, even in Germany, the tenth National Health Goal on Patient Safety was established in 2022 (Holtz & Jonitz, 2023). This goal also calls for the active involvement of patients, their relatives, or representatives, e.g., through the use of appropriate tools. B. by promoting patient safety competence and supporting patients in their active participation in the development of measures.
04.12.2023
Quality and benefit are also frequently used terms in the healthcare system, with which we emphasize that significant resources are used to ensure optimal “quality of care” and to create “benefits” for those affected. Examples are the proportion of medical manpower (approx. 20%) that is committed to quality assurance and the expenses that arise as part of the approval of medicines for the creation of benefit dossiers (approx. 1 million euros/dossier). Quality and benefit are are therefore used as different dimensions of added health value, whereby quality could be a necessary prerequisite for providing benefit, but benefit is not necessarily a prerequisite for quality. The increasing scarcity of resources in health systems requires not only the critical analysis of new expenditure, but also the justification of existing expenditure. The not insignificant expenditure on ensuring the quality and benefit of health services can no longer be accepted as an end in itself1. On the one hand, they must be subjected to a “clinical-economic” analysis, through which the effort and the returns achieved for patients and society are compared. In addition, the differentiated analysis of quality and benefit opens up new considerations for financing health services. In order to carry out this analysis, it is first necessary to describe what is meant by “quality” and “benefit” in the healthcare system.
31.03.2015
Healthcare innovations aim to make healthcare better and/or more economical. Important starting points and components (without claiming to be exhaustive) are in particular: process optimization with a view to the entire treatment chain, the development of incentive mechanisms for prevention, remuneration models with a focus on the quality of results and not on the quantity and number of services, and active patient participation.
24.01.2013
Pay for Performance – An Option for Germany? Germany is considered a developing country when it comes to "pay for performance" (P4P). P4P has also established itself in Germany as a term for strategic compensation systems in which a portion of compensation is tied to measured performance levels. Two recently published reports (Veit et al. 2012 and Charlesworth et al. 2012) […]
25.09.2012
The aim of the study was to analyze DRG-attributable effects on the care process in and around the hospital. On the basis of 30 representatively selected hospitals in Lower Saxony and using a differentiated methodology, it was possible to show: 1. The quality of direct patient care in the hospital has largely not changed due to the introduction of the DRG. 2. There is no evidence for a targeted selection of lucrative treatment cases. 3. The phenomenon of a "bloody dismissal" cannot be proven. 4. An increase in unplanned readmissions ("revolving door effect") in the course of the introduction of the DRG cannot be proven. 5. The hospitals have created the essential prerequisites for the operational implementation of the DRG system; a future-oriented strategic alignment and a consistent process design has only been partially implemented. 6. The working conditions have changed in the course of the introduction of the DRG, with the documentation and coding effort being overestimated. 7. The medium-sized and large hospitals are largely economically successful even under DRG conditions because they can use the opportunities for strategic realignment, while this is much more difficult for the smaller hospitals.
01.04.2010
When it comes to health care research, health economics emphasizes distributing scarce resources in such a way that overall maximum coverage of needs, measured in terms of patient benefit, is achieved. This means providing care as efficiently as possible, while from a medical perspective the most effective measure - regardless of costs - would be preferred. Using ex ante cost-benefit analysis, it is possible to model various alternative courses of action or care concepts. After an appropriate observation period, a re-evaluation of the everyday care data obtained makes sense. The aim is the targeted and continuous optimization of the quality of care, not cost containment. The actual cost-benefit ratio of a implemented care concept can help here. Health care research that focuses only on the costs or only on the benefits cannot result in optimal care from an economic perspective. For this reason, it is important to pay more attention to efficiency through cost-benefit assessment in health care research.