Abstracts by keywords: Quality
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
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
Patient safety in healthcare has increasingly become the focus of global attention. It is defined as the "avoidance, prevention, and improvement of adverse events or injuries resulting from healthcare processes" (Campbell et al., 2020). At the 74th World Health Assembly (2021), the World Health Organization (WHO) presented a global action plan to prevent health threats and harm to patients arising from healthcare (World Health Organization, 2021). Strategic Goal 4 of this action plan explicitly calls for active patient involvement (PD) in the further development of healthcare. Given the continued significant number of preventable adverse events in medical healthcare, even in Germany, the tenth National Health Goal on Patient Safety was established in 2022 (Holtz & Jonitz, 2023). This goal also calls for the active involvement of patients, their relatives, or representatives, e.g., through the use of appropriate tools. B. by promoting patient safety competence and supporting patients in their active participation in the development of measures.
04.12.2023
Many topics that have dominated the health policy discussion in Germany and internationally in recent years have been pushed into an almost distant background due to the Corona crisis1. Quality orientation as a central paradigm - who is still aware of the intensity with which the quality offensive was discussed in the middle of the last decade, the patient safety issue was at the forefront, competitive elements such as pay for performance heated up emotions, patient autonomy was held up as the greatest asset and the patient -Reported outcomes were celebrated as cornerstones of quality measurement. Perhaps the most difficult task today is to restore continuity between the present determined by Corona and the themes of this seemingly distant past. Not everything can have been wrong, but on the other hand, it must be recognized that Corona has meant that some of the assumptions and certainties from just a year and a half ago that were considered unchangeable require intensive discussion and addition. The present text can only outline the problem and present a work program based on a few examples. A detailed derivation of the conceptual consequences based on the previous findings from the corona pandemic and the technical and scientific foundations of the quality and safety discussion of the last decades must be reserved for the in-depth discussion in the next few years and will take on a considerably larger scope.ckende Acute diseases such as stroke and myocardial infarction are documented less frequently. The behavioral change that resulted from the implementation of strict hygiene rules may also have led to a “real” decrease in the rates of non-Covid-19 infectious diseases (5,6). In other words, the measures taken to combat the Covid-19 pandemic may also have influenced the spread of other germs that cause respiratory tract infections (AI) and gastrointestinal infections (GI). For this reason, in the present study the authors wanted to investigate the frequency of these AI and GI during the Covid-19 pandemic using data from a large database that includes anonymized treatment information from general practitioners and pediatricians 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
Quality and benefit are also frequently used terms in the healthcare system, with which we emphasize that significant resources are used to ensure optimal “quality of care” and to create “benefits” for those affected. Examples are the proportion of medical manpower (approx. 20%) that is committed to quality assurance and the expenses that arise as part of the approval of medicines for the creation of benefit dossiers (approx. 1 million euros/dossier). Quality and benefit are are therefore used as different dimensions of added health value, whereby quality could be a necessary prerequisite for providing benefit, but benefit is not necessarily a prerequisite for quality. The increasing scarcity of resources in health systems requires not only the critical analysis of new expenditure, but also the justification of existing expenditure. The not insignificant expenditure on ensuring the quality and benefit of health services can no longer be accepted as an end in itself1. On the one hand, they must be subjected to a “clinical-economic” analysis, through which the effort and the returns achieved for patients and society are compared. In addition, the differentiated analysis of quality and benefit opens up new considerations for financing health services. In order to carry out this analysis, it is first necessary to describe what is meant by “quality” and “benefit” in the healthcare system.
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
31.03.2015
Healthcare innovations aim to make healthcare better and/or more economical. Important starting points and components (without claiming to be exhaustive) are in particular: process optimization with a view to the entire treatment chain, the development of incentive mechanisms for prevention, remuneration models with a focus on the quality of results and not on the quantity and number of services, and active patient participation.
24.01.2013
Influence of insurance status and income on waiting times in the outpatient sector. The length of the waiting time for an appointment in the outpatient and inpatient sectors is considered an important quality indicator and a significant parameter for access to medical care in most countries. Since waiting times are often perceived as an implicit form of rationing of healthcare services, this […]
25.09.2012
Pay for Performance – An Option for Germany? Germany is considered a developing country when it comes to "pay for performance" (P4P). P4P has also established itself in Germany as a term for strategic compensation systems in which a portion of compensation is tied to measured performance levels. Two recently published reports (Veit et al. 2012 and Charlesworth et al. 2012) […]