RESUMEN
The German self-governing bodies have concluded an agreement about ambulant operations and procedures which replaces the inpatient health care situation. It came into force on January 1, 2004. The published catalogue contains specific treatment procedures which define more clearly some problems that occur between the provision of outpatient and inpatient services in the German health care system. Clinical physicians and practising specialists now have equal rights to provide and to charge for the ambulant services that are included in this agreement. These conditions will play a role in the daily routine of hospitals and will influence treatment patterns. A comprehensive knowledge of the basic principles is essential. In the present article, the compulsory agreement and some resulting consequences are elucidated with special relevance to gastroenterology.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/legislación & jurisprudencia , Procedimientos Quirúrgicos Ambulatorios/normas , Manejo de Atención al Paciente/legislación & jurisprudencia , Manejo de Atención al Paciente/normas , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/normas , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos del Sistema Digestivo/economía , Procedimientos Quirúrgicos del Sistema Digestivo/legislación & jurisprudencia , Procedimientos Quirúrgicos del Sistema Digestivo/normas , Documentación/normas , Alemania , Humanos , Pacientes Internos , Manejo de Atención al Paciente/economía , Garantía de la Calidad de Atención de Salud/economíaRESUMEN
Since January 2004, German hospitals and specialists in private practice have equal rights to provide and to charge for ambulatory surgeries according to paragraph 115b, 5th Code of Social Law. The current agreement between the German self-governing bodies replaces the existing contracts from 1993. In contrast to the previous version, the revised catalogue contains additional non-operative procedures. Some procedures may be provided either in an ambulatory or inpatient setting. However, for the hospitals it is of particular importance that some specified procedures should be performed on an ambulatory basis. If these particular services are delivered in an inpatient setting at least one stipulated criteria of exception has to be fulfilled. From the perspective of dermatology, not only opportunities but also obligations for ambulatory care arise from the new conditions. The critical facts and aspects with special relevance to dermatology are reviewed in detail.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Admisión del Paciente/legislación & jurisprudencia , Mecanismo de Reembolso/legislación & jurisprudencia , Enfermedades de la Piel/cirugía , Ahorro de Costo/legislación & jurisprudencia , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Alemania , HumanosAsunto(s)
Grupos Diagnósticos Relacionados/economía , Planes de Aranceles por Servicios/economía , Precios de Hospital/legislación & jurisprudencia , Seguro de Hospitalización/economía , Programas Nacionales de Salud/economía , Análisis Costo-Beneficio/legislación & jurisprudencia , Financiación Gubernamental/economía , Alemania , HumanosAsunto(s)
Grupos Diagnósticos Relacionados/economía , Planes de Aranceles por Servicios/economía , Reforma de la Atención de Salud/economía , Precios de Hospital/legislación & jurisprudencia , Seguro de Hospitalización/economía , Programas Nacionales de Salud/economía , Análisis Costo-Beneficio/legislación & jurisprudencia , Grupos Diagnósticos Relacionados/clasificación , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Planes de Aranceles por Servicios/legislación & jurisprudencia , Alemania , Reforma de la Atención de Salud/legislación & jurisprudencia , Humanos , Seguro de Hospitalización/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudenciaAsunto(s)
Grupos Diagnósticos Relacionados , Ortopedia , Traumatología , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/organización & administración , Alemania , Humanos , Procedimientos Ortopédicos/economía , Ortopedia/economía , Traumatología/economía , Heridas y Lesiones/economía , Heridas y Lesiones/cirugíaRESUMEN
With the statutory health insurance reform act 2000 the German government started to introduce a new hospital funding system based on an internationally used diagnosis related groups (DRGs) system. In June 2000 the German self-administration board (consisting of the German hospital federation, the German statutory health insurance funds and the association of private health insurers), which is in charge of realizing this project, decided to develop the future German (Refined) DRG System (G-DRG) with reference to the Australian Refined DRG System (AR-DRG) Version 4.1. Replacement of the previous German hospital reimbursement system by the new DRG-based hospital funding system is planned for January 2003 on a voluntary basis. From January 2004 on, the change of the reimbursement system is to become mandatory for all hospitals with the exception of psychiatry. The new reimbursement system is intended to not only cover acute hospital care but also parts of early rehabilitation, palliative and sub-acute care. Because of its economic incentives the effects of DRG introduction in Germany will not only be limited to the hospital scene but will also affect rehabilitation.
Asunto(s)
Grupos Diagnósticos Relacionados/economía , Reembolso de Seguro de Salud/economía , Programas Nacionales de Salud/economía , Centros de Rehabilitación/economía , Control de Costos/legislación & jurisprudencia , Alemania , Implementación de Plan de Salud/legislación & jurisprudencia , HumanosRESUMEN
In 2000, the responsibility for selecting a DRG variant for use in Germany was assigned to a body comprising representatives of hospitals and insurers called the Self-Administration Board (or Board in this paper). To help the Board, we applied cardiac surgery data from 18 German hospitals to eight different DRG variants. The error caused by bad coding quality could be minimized this way, since all diagnoses and procedures in cardiac surgery must be recorded for quality assurance purposes. To match the German code to the appropriate code required by the DRG variant, we created mapping tables whenever needed. As far as cardiac surgery is concerned, the Australian AR-DRG and the French GHM variants provided the best medical relevance, while the AR-DRG variant considered the level of severity better. Other variants would have to be updated to better reflect the level of medical complexity. Three main causes for wrong grouping could be identified for all systems: incomplete mapping, not enough reference to multidisciplinary treatments, and system construction problems.