Abstracts by keywords: out-patient services replacing hospitalization
Medical progress and changes in medical care structures result in a changed division of labor between practicing physicians and acute inpatient hospitals. Increasingly, outpatient doctors are also providing medical services that previously required an inpatient stay - such as dialysis or lens operations on the eye. This results in a shift of services from the inpatient to the outpatient care sector, which generates “new” services in the outpatient sector. In the context of this work, these services will be referred to as “station-replacing” services and will be specifically analyzed. In addition, other services can be relocated; namely those that can in principle be provided in both sectors, but are increasingly being provided on an outpatient basis as inpatient care structures are dismantled and due to lower costs. This type of service shift is not examined in this work. The reason for this presentation is the intention to make service shifts from the inpatient to the outpatient sector of the healthcare system the subject of contract medical requirements planning (von Stillfried/Czihal 2015). Shifts in services can be seen in the fact that increases in statutory medical services are particularly visible where a corresponding decrease in inpatient billing and occupancy days is calculated, which was shown for certain diagnoses when outpatient services increased (Czihal et al 2013). A further development of this approach would be conceivable, for example with a presentation of billed services for cases with the relevant diagnoses. In this way, the scope of relocated services could be specified and calculated. Due to comorbidities in outpatient cases and a lack of distinction between main and secondary diagnoses in statutory health insurance billing, services for different diagnoses could be counted multiple times. Increasing outpatient service requirements are calculated for 17 of 20 ICD-10 chapters (Czihal et al 2013.). Since the increasing trend in statutory health insurance services can be found in the majority of diagnostic chapters, it would be helpful for the question to be able to narrow this down to certain “station-replacing” services.