[Introduction of the DRG system from the point of view of private health insurers].
For the first time, there has been a worldwide attempt to fund all hospital services almost completely by a DRG system supplemented by additional charges, rebates, and procedural rates. In the interest of the efficiency and transparency of hospital services the introduction of a German DRG system settling the current implausible price differences would be welcome. The system selected by the medical self-governing bodies in Germany is based upon the Australian AR-DRG classification. In contrast to other systems, the latter provides the best medical plausibility, the highest transparency of the assignment algorithm and the highest potential for flexibility and adaptations to changing morbidity patterns and medical progress. The adaptation to the conditions of the German health care system requires considerable efforts on the part of hospitals as well as sickness funds and health insurers. Hospitals need to establish a cost unit accounting system satisfying the rules of Applied Economics to allow, among other things, the calculation of relative cost weights. The self-governing bodies will have to consent on a complex regulation system. The German Hospital Federation declared the break down of negotiations concerning a provisional DRG system to be optionally available to hospitals in 2003. The Federal Ministry of Health will now have to decide whether to implement the system through executive fiat. The comprehensive DRG system will introduce new risks. The economic risks of the individual hospital, though not the individual insurer's risks, will be partially compensated for in the introductory phase by revenue balance mechanisms, for example. In particular, both the privately insured and civil servants will face a rise in costs as they will no longer benefit from a shorter length of hospital stay. To end this discrimination against private health insurers, the double counting of the costs associated with medical treatment (included in the DRG price and additionally invoiced by the physician) must be avoided: Once the current reimbursement for costs of optional medical services--being mainly a subsidy borne by private patients--is discontinued, the fee reduction according to Sect. 6a GOAe (medical fee schedule) must be adjusted definitely. This new primacy of economics could pose a threat to the quality of medical treatment. Therefore, quality assurance directives find increasing relevance. Preferably, healthcare providers should rigorously adhere to their scientific standards. Only a strictly rule-based introduction and the system's annual adaptation can keep the risks calculable.
Fritze
Jürgen
J
juergen.fritze@pkv.de
Miebach
Jürgen
J
Hüdig
Wolfgang
W
D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D005858:Germany; D007348:Insurance, Health / Q000639:trends*