Abstracts by keywords: hospital
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
Previous studies have reported increased in-hospital mortality in patients with dementia (PwD), but findings across age groups, clinical departments, and admission diagnoses have been limited. The aim of this study is to compare in-hospital mortality in PwD across age groups, clinical departments, and admission diagnoses with that of control subjects without dementia.
03.12.2024
Differences by facility type and relationship with work ability and burnout risk
01.10.2024
The ongoing corona pandemic shows us every day how important up-to-date and valid information is for restoring, maintaining and promoting health. How easy or difficult it is to access health-related information and materials is largely determined by the environments in which we live and work - and thus the so-called organizational health competence (Ernstmann et al. 2020; Schaeffer et al. 2018). In addition to the individual ability to deal with health-related information, organizations and institutions in particular are responsible for supporting the procurement and handling of health information for users (i.e. patients, residents, clients and relatives) (Ernstmann et al . 2020; Schaeffer et al. 2018). For example, the use of foreign words in health-related information makes comprehension more difficult, while texts in simple language are also easier to understand for people with a low educational background or cognitive impairments (Pelikan/Dietscher 2015). Management and specialist staff in particular play an important role in the provision and handling of health-related information for users and their health literacy (DeGani et al. 2020). Acute diseases such as stroke and myocardial infarction are documented less frequently. The change in behavior resulting from the implementation of strict hygiene rules may also have led to a “real” decrease in rates of non-Covid-19 infectious diseases (5,6). In other words, the measures taken to combat the Covid-19 pandemic may also have affected the spread of other germs that cause respiratory (AI) and gastrointestinal (GI) infections. For this reason, in the present study, the authors wanted to examine the frequency of these AIs and GIs during the Covid-19 pandemic using data from a large database that includes anonymized treatment information from general practitioners and paediatricians in Germany.
28.01.2022
The discussion about the structure of hospital care is characterized by two theses: On the one hand, there is an argument for concentrating hospital care on a smaller number of locations. This is justified not only with reference to a higher cost-effectiveness of hospital care and a more efficient use of scarce human resources, but also with a higher quality of care, especially in more complex procedures for which a positive volume-outcome relationship can be proven. From another perspective, however, it is argued, among other things, that greater concentration worsens the accessibility of hospital care, especially in rural regions, while additional quality gains from greater concentration can either no longer be expected or can be expected in another way - for example through increased concentration use of telemedicine – could be achieved. And from a competition theory perspective, too much concentration could have a negative impact on the intensity of competition between hospitals and thus reduce incentives for quality. What is striking in this discussion is that relatively little is known about the actual concentration of hospital care and its development. The aim of this article is therefore to examine at different levels and from different perspectives how highly concentrated hospital care in Germany is currently, how the concentration has changed in recent years, and where there is still potential for increasing the quality of care through a higher level of care Concentration of hospital care exist1.
22.09.2021
Results of a Delphi survey and retrospective data analysis
07.06.2021
For a better understanding of the following explanations, it is important to point out that volume development is only a partial aspect of the economization of the healthcare system. Other aspects include, among other things, the shortage of material and human resources as well as the premature transfers/discharges of patients. These aspects cannot be directly subordinated to the topic of volume development, but should certainly be taken into account in the planned study. The subtitle of the sub-topic dealt with in this article as “volume development” is not intended to distract from the fact that this is also an explosive medical-ethical and legal problem area. Statistically speaking, examinations and treatments that are not medically indicated have a potential for harm, which is contradicted by the Hippocratic principle of “Primum nil nocere”. This aspect is not discussed here either, but is taken into account in the planned study.