Abstracts by keywords: certification
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
According to the National Cancer Plan, all cancer patients should receive high-quality care in accordance with evidence-based treatment guidelines in uniformly qualified centers. The WiZen study demonstrated significant survival benefits for all 11 cancer types examined when receiving initial treatment in a center certified by the German Cancer Society (DKG) compared to non-certified hospitals. Nevertheless, a high proportion of cancer patients are treated in non-certified hospitals. The Hospital Care Improvement Act (KHVVG) provides for a concentration of services in the field of oncological surgery; the hospital locations that collectively provide the fewest and 15% of cases with corresponding onco-surgical services for a cancer entity are to be exempt from reimbursement. We used an impact analysis based on data from Section 21 of the KHEntgG (German Hospital Care Improvement Act) for 2022 to examine the extent to which the planned concentration of services will lead to the implementation of the National Cancer Plan and the results of the WiZen study. The entities considered were breast cancer, pancreatic cancer, bronchial cancer, colon cancer, rectal cancer, gastric cancer, and esophageal cancer. Of the sites that would meet the criteria of the KHVVG, between 17.9% (breast cancer) and 85.5% (gastric cancer) are not certified according to the DKG criteria. Thus, if Section 40 of the KHG (new) is implemented, a significant proportion of patients would continue to be treated outside of certified centers, leaving corresponding quality potential untapped. Furthermore, the proposed new regulation only addresses surgical interventions per (cancer) entity—thus exempting all non-oncosurgical cancer treatments from the quality-based service concentration. Overall, to achieve the goal of hospital reform—namely, to improve the morbidity and mortality of patients with cancer—it appears significantly more effective to limit oncological care, as envisioned in the National Cancer Plan, exclusively to those facilities that meet the certification requirements of the German Cancer Society and thus demonstrably ensure guideline-compliant, evidence-based care for cancer patients. According to an analysis by the government commission, this would not significantly restrict accessibility for the population.