What is the flat rate System?
In the case of flat-rate System, diagnoses are grouped into “event groups” and paid with a lump sum – according to the rule-of-thumb: the higher the effort, the more money. The case-based lump sum catalogue includes more than 1200 such groups. In addition to the “main diagnosis” are included in the calculation of the compensation factors, such as comorbidities or demographic data, in addition, the “procedures” – all of the medical interventions of the syringe via a gastroscopy to operations. In Germany, use the English designation for lump-sum payments: “DRG” (Diagnosis Related Groups) is.
Where does the flat rate System?
Australia provided the model for the case-based lump sum System. However, it is used different there. Although it is a statutory requirement in Australia to encode for all of the hospital patients at discharge a diagnosis. However, only a part of the financing, on case-runs, in addition, each hospital receives a fixed Budget.
When and why was it introduced?
In the 90s, politicians and health insurance companies were afraid of a “cost explosion” in health care. Hospitals operated mismanagement at the expense of the Insured. They were given fixed amounts for each day the patient spent there, no matter how hard they were ill. They kept you longer than necessary, especially over the weekend. The German case-System (“G-DRG”), introduced in 2003, should protect patient from: A “main diagnosis”, a payment per case flat rate – that should force ensure transparency, the Fund will keep contributions stable, but especially the hospitals in a competition against each other.
What’s to criticize Doctors on the case-based lump sum System?
Dangerous, the case flat-rate System will only be used in combination with the high economic pressure that prevails today in many German clinics. The hospitals should, wherever possible, generate black zeros, or even profits, and the flat rate System provides many Disincentives for it. Because patients expect – no matter how sick you are – especially if at them a lot of “procedures” can be performed. And the more “cases” in a hospital in the same period, by discharged, the higher revenue it achieves. You will be rewarded so activism. The often correct to Wait and Think about the best therapy, according to this logic lost time. The consequences are reflected in the statistics: the number of hospital treatments is growing steadily in Germany, Europe’s unique development. And so it is that in this country, more Doctors than in most comparable countries, but they have per “case” in the least amount of time. Many Doctors complain that in the efficiency-driven hospital medicine is no more time for patient talks. You have to fight also with one according to the estimates on the three – to five-fold increase in administrative expenses. Because every, even the smallest procedure must be documented. Without documentation, no money.
What would be a solution? What needs to change?
First of all, each hospital is asked to doctor to put economic constraints, if this hurt the patient’s well-being. The Doctors-Codex “medicine Economics” that arose at the instigation of the German society for Internal medicine (DGIM) and behind the more than 30 professional organizations flocking calls for it. Another possibility would be that hospitals get, regardless of the case-base amounts for all of the previously shown poorly in the payroll system. Would benefit large hospitals, if you provide a lot of heavy, poorly rewarded cases and patients with rare diseases, but also the small district hospital, the survival for an underserved Region is important. There are bitter arguments currently on the question of whether or not just hospitals closed and others must be better equipped with staff and technology. Nearly 2000 hospitals in Germany, there are – per capita, more than anywhere else in the world. About 800 to 1000 were superfluous, so the estimates. But such a strategy requires a long breath – and a willingness to invest. As a model for Denmark, the following applies: There was developed in the early 2000s, a master plan, new hospitals were built where there were none before, the rescue service was re-established that organized care differently. Result: Today houses the Danish 25 great sick. In Germany there is no such Plan, the hospital landscape has grown over the decades in the wild. And what would happen if politicians would now follow the loud call for hospital closures, without having to worry about the wrong incentives? There is then, only with fewer clinics. That would be disastrous.
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