Alexander Geissler
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Prof. Dr.
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Geissler
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Alexander
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alexander.geissler@unisg.ch
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+41 71 224 30 17
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  • 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
    ;
    Geissler, Alexander orcid-logo
    ;
    Quentin, Wilm
    ;
    Klauber, Jürgen
    ;
    Geraedts, Max
    ;
    Friedrich, Jörg
    ;
    Wasem, Jürgen
    ;
    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.
    Type: book section
    URL: https://link.springer.com/chapter/10.1007/978-3-662-60487-8_4
    DOI: 10.1007/978-3-662-60487-8_4
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/113132
  • Publication
    Der Einsatz von Qualitätsinformationen für Krankenhausplanung und Leistungseinkauf in Frankreich, Italien, Niederlande, Österreich und der Schweiz
    (Schattauer GmbH, 2018)
    Geissler, Alexander orcid-logo
    ;
    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.
    Type: book section
    URL: https://www.wido.de/publikationen-produkte/buchreihen/krankenhaus-report/2018/
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/101190
  • Publication
    Umgestaltung der Notfallversorgung: Internationale Erfahrungen und Potenziale für Deutschland
    (Schattauer GmbH, 2017)
    Geissler, Alexander orcid-logo
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    Quentin, Wilm
    ;
    Busse, Reinhard
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    Klauber, Jürgen
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    Geraedts, Max
    ;
    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.
    Type: book section
    URL: https://www.wido.de/publikationen-produkte/buchreihen/krankenhaus-report/2017/
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/103048
  • Publication
    Ambulante Leistungen von Krankenhäusern im europäischen Vergleich
    (Schattauer GmbH, 2016)
    Geissler, Alexander orcid-logo
    ;
    Quentin, Wilm
    ;
    Busse, Reinhard
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    Klauber, Jürgen
    ;
    Geraedts, Max
    ;
    Friedrich, Jörg
    ;
    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.
    Type: book section
    URL: https://www.wido.de/publikationen-produkte/buchreihen/krankenhaus-report/2016/
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/105113
  • 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
    ;
    Reiche, Claudia
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    Röttger, Julia
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    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    ;
    Klauber, Jürgen
    ;
    Garaedts, Max
    ;
    Friedrich, Jörg
    ;
    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.
    Type: book section
    URL: https://www.wido.de/publikationen-produkte/buchreihen/krankenhaus-report/2012/
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/92846