Abstracts by keywords: area coverage
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.