Now showing 1 - 8 of 8
  • Publication
    Vergütung von spezialisierten, seltenen und kostenvariablen Fällen außerhalb des DRG-Systems: Erfahrungen aus Deutschland, Dänemark, England, Estland, Frankreich und den USA
    (Springer-Verlag GmbH, 2020)
    Stephani, Victor
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    Quentin, Wilm
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
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    Beivers, Andreas
    The aim of this chapter is to compare hospital payment systems across countries, and to identify what payment mechanisms are used beyond DRG-based payments. The focus is on payment mechanisms that aim to account for highly specialized, variable, or low volume care. The following countries were included in the analysis: Germany, Denmark, England, Estonia, France, USA (Medicare Part A). A questionnaire was developed to collect information about elements excluded from DRG-based payment, why this is the case, and what payments are available. The results were summarised in a model which serves to systematically describe, visualise and compare these payment mechanisms. The results show that all countries have implemented financing mechanisms in addition to DRG-based payment. In most cases, a large number of additional payment mechanisms are applied in order to allow adequate reimburse-ment forcomplex, rareorvariablecases. However, their complexity varies. While countries such as England and Germany use many different additional mechanisms, there are significantly fewer exceptions to DRG-based payment in other systems, such as the Medicare program in the US. Apart from that, care areas excluded from DRG-based payment differ significantly. In Denmark, highly specialised services provided in designated hospitals are excluded from DRG-based payment. In England, designated hospitals receive top-up payments when treating highly specialized patients. In view of the necessary and much discussed concentration of (highly) specialised services in Germany, future reforms of the hospital payment system could be inspired by the Danish (or English) examples and create incentives to support the concentration of highly specialized care.
  • Publication
    Paradigmenwechsel in der Krankenhausplanung – hin zu Leistungs-, Bedarfs- und Qualitätsorientierung für einen höheren Patientennutzen
    (Springer-Verlag GmbH, 2020)
    Vogel, Justus
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    Letzgus, Philipp
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
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    Beivers, Andreas
    In Germany, hospital capacity planning goals are well defined. Hospital capacity planning must be demand driven and is to secure high quality care for patients treated in economically efficient hospitals. The traditional planning method that is currently used in all states in Germany can no longer meet these requirements. This planning method employs medical areas of expertise for the distinction of treatments, it uses an undifferentiated application of the Hill-Burton Formula to forecast future demand and only selectively applies quality requirements for the allocation of licenses for inpatient care. In this article, we develop a new planning method that is based on a detailed system of treatment areas structured in a medically meaningful hierarchy (treatment orientation). This system is used to assess the current care situation and to conduct a sophisticated forecast of future demand with quantitative consideration of relevant influence factors (demand orientation). Finally, a method to develop qual-ity requirements per treatment area is presented (quality orientation). The article concludes with the drafting of a planning process for this new treatment, demand and quality oriented hospital capacity planning method.
  • Publication
    Benchmarking der Krankenhaus-IT: Deutschland im internationalen Vergleich
    (Springer-Verlag GmbH, 2019)
    Stephani, Victor
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    Busse, Reinhard
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    Digitalisation is finding its way into German hospitals. However, the level of information technology (IT) utilisation remains unclear. Therefore, this paper analyses the degree of digitalisation of German hospitals from an international perspective. For this purpose, the logic of the “Electronic Medical Record Adoption Model” (EMRAM) is used, which rates hospitals on a scale from 0 (no digitalisation) to 7 (paperless hospital). According to the EMRAM logic, German hospitals achieve an average value of 2.3 and are therefore digitised only below average compared to other countries. The gap to the European average (3.6) has also widened in recent years. Countries such as Turkey (3.8) or the USA (5.3) are much more advanced. Currently, there is not a single hospital at Level 7 in Germany. Other evaluation methods, such as the “European Hospital Survey”, confirm the results of EMRAM and show that Germany is increasingly losing ground in the digital field. The reasons for this poor balance include a lack of investment, data protection concerns, the user-unfriendliness of the IT systems used and the sluggish broadband expansion in Germany. It is important to define achievable goals and to use existing resources carefully for IT expansion. Only by creating uniform standards and a reliable IT infrastructure, new technologies can be implemented sustainably.
  • Publication
    Der Einsatz von Qualitätsinformationen für Krankenhausplanung und Leistungseinkauf in Frankreich, Italien, Niederlande, Österreich und der Schweiz
    (Schattauer GmbH, 2018) ;
    Lee, Sherry
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    Quentin, Wilm
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    Some European countries use information on hospital quality within the planning process to allocate services to the most appropriate provider. Specif c hospital planning is commonly driven by mandates and stewardship at the national level and is conducted at the regional level. In general, four sets of policy levers are used. First, countries use legal mandates to oblige quality-based considerations in planning or purchasing on national level. The second policy involves conducting qualifying quality assessments. The process identif es hospitals and departments that meet the quality criteria. Thirdly, some examples show that selective contracting or planning is possible. This enables purchasers to contract only those providers who are most likely to produce good quality care. And finally, centralisation of highly specialized medical procedures allows for the accumulation of experience for low volume and high technicality procedures. Similar initiatives should be considered to become part of a nationwide planning approach in Germany to further develop the hospital landscape for future challenges.
  • Publication
    Umgestaltung der Notfallversorgung: Internationale Erfahrungen und Potenziale für Deutschland
    (Schattauer GmbH, 2017) ;
    Quentin, Wilm
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    Busse, Reinhard
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    Similar to Germany, many other countries have witnessed a considerable increase in the utilisation of emergency departments. The reasons for this are complex. However, patient preferences and limited access to primary care (out-of-hours) services seem to be important drivers. Australia, Denmark, England, France and the Netherlands have implemented a number of measures to face these challenges. Based on these international experiences, two implications for Germany stand out. First, steering patients to the most appropriate provider is important because it can increase the quality of care for highly severe cases (emergency protocols, establishment of specialised treatment centres) and rationalise the provision of care for non-urgent cases (integrated call centres). Second, experiences from Denmark and the Netherlands demonstrate that better coordination between primary care and emergency departments (common entry point and triage) can moderate the utilisation of emergency departments.
  • Publication
    Ambulante Leistungen von Krankenhäusern im europäischen Vergleich
    (Schattauer GmbH, 2016) ;
    Quentin, Wilm
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    Busse, Reinhard
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    In contrast to many other European countries, ambulatory services in Germany are traditionally mostly provided outside of hospitals. This is evident in international comparisons when looking at the share of expenditures for outpatient care provided by hospitals (in Germany 2.8%, in Portugal 39.8%), the share of physicians working at hospitals, the share of day cases or the organisation of secondary care provision. However, in the context of emergency care services, patients’ expectations of receiving more convenient and better accessible care for non-urgent or minor problems have led to increasingly crowded emergency departments. International experience suggests that different activities aiming at a better coordination of care, such as integrated call centers, extending out-of-hours services and offering ambulatory services within or nearby hospitals, can help to steer patients to the most appropriate provider. However, innovative and integrated health care service models are in conflict with the fragmented payment and planning structures in Germany.
  • Publication
    Stationäre Kapazitätssteuerung im internationalen Vergleich
    (Schattauer GmbH, 2015) ;
    Busse, Reinhard
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    Klauber, Jürgen
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    Geraedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    Planning and steering of hospital capacities is regulated in many countries. However, the approaches differ based on national health targets, the degree of political decentralisation and the scope of planning. Moreover, different capital investment strategies are used for capacity building. There is a trend towards service planning in order to deliver basic care close to the residence of patients and highly specialised care in selected treatment centres throughout the country.
  • Publication
    Technologische Innovationen und DRGs: Ein Vergleich der Vergütungsinstrumente in elf europäischen Ländern
    (Schattauer GmbH, 2012)
    Scheller-Kreinsen, David
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    Quentin, Wilm
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    Reiche, Claudia
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    Röttger, Julia
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    Busse, Reinhard
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    Klauber, Jürgen
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    Garaedts, Max
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    Friedrich, Jörg
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    Wasem, Jürgen
    Payment mechanisms are important factors for the use and diffusion of technological innovation. Nevertheless, there is a lack of knowledge and empirical evidence about the payment instruments and mechanisms used for technological innovation in the inpatient sector across European health care systems. Given this background, this articles discusses the relationships between DRG-based payment systems and technological innovation. Moreover, it analyses available short-term payment instruments for technological innovation and their application across eleven European countries. The article also scrutinizes how technological innovations are integrated into DRG-based payment systems in the long run. We fi nd that long term mechanisms differ with respect to i) the frequency of system updates, and ii) the time-lag to the data used for these updates. Our analysis suggests that one can differentiate between different kinds of short-term payment instruments: on the one hand some countries apply separate payments outside the core scope of DRG-based payment systems. On the other hand countries provide additional payments and cost-outlier funding that operates within the framework or at the margin of DRG-based payment systems. Overall, our analysis suggests that payment approaches in the context of DRG-based pay-ment systems differ substantially across European health care systems. German as well as other European policy makers should pay more attention to the diversity of payment approaches across European health care systems to inform their policy making.