Abstracts by keywords: hospital reform
The consolidation of the hospital market is driven by economic constraints, as smaller facilities are often no longer able to operate profitably. The trend toward centralization is being politically promoted by hospital reform and is intended to improve the quality of care through specialization and concentration of resources. However, by 2022, only 1,075 hospitals in Germany had intensive care capacity [1].
03.12.2024
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.
04.08.2024
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
Two areas must play a key role in the current discussion about efficient networked care between the inpatient and outpatient sectors. The current lowest level of care in the desired hospital reform is considered - the so-called Level Ii of integrated outpatient-inpatient care as well as the area of sector-equivalent care and remuneration in accordance with Section 115 f SGB V. Both areas have the potential to achieve a far-reaching position within the framework of high-quality medical care However, efficient patient care is not considered worthwhile in the current legislative process.
03.10.2023
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).
31.03.2015
With the Hospital Structure Act (KHSG)1, politicians are once again focusing on the hospital sector for a comprehensive reform, six years after the Hospital Financing Reform Act (KHRG)2. As similar as the two acronyms are, the focus of many of the measures in these laws is different. While the KHRG specifically focused on financing under the framework conditions of a DRG per-case flat-rate system with many new degrees of freedom for hospitals that was being fully applied for the first time, the KHSG's measures point in the right direction under the impression of a considerable number of false incentives that have arisen as a result structural specifications and planning bonds. The deregulation of the KHRG is followed by a regulatory approach again