Das Krankenhausfinanzierungsreformgesetz : ein weiterer Schritt auf dem Reformweg der Krankenhausfinanzierung

Seit 2003 wird die Krankenhausvergütung in Deutschland schrittweise auf ein neues, leistungsorientiertes System auf Basis von Fallpauschalen (diagnosis related groups – DRG) umgestellt. Die Über gangsphase, in der gesonderte gesetzliche Regelungen gegolten hatten, sollte Ende 2008 auslaufen, weshalb der gesetzlichen Rahmen für die Nachkonvergenzzeit neu geregelt werden musste. Neben diesen technischen Regelungen und einem einheitlichen Bundesbasisfallwert standen auch die Reform der Investitionsfinanzierung, der weitere Ausbau des Wettbewerbes und die schlechte Finanzsituation der Krankenhäuser auf der Agenda des Krankenhausfinanzierungsreformgesetzes (KHRG). Aufgrund der heterogenen Interessenslagen von Bund und Ländern, gestaltete sich auch bei diesem Reformgesetz die Kompromisssuche schwierig. Herausgekommen ist ein Gesetz, dass die Reformpolitik der letzten Jahre weiterführt, die Aufgabe der zukünftigen Sicherstellung der bedarfsgerechten Versorgung aber nicht löst und die problematischen Auswirkungen des DRG-Systems negiert. Das Diskussionspapier zeichnet die wichtigsten Schritte des Gesetzgebungsprozesses nach, präsentiert und diskutiert die wichtigsten Inhalte des Gesetzes und ordnet das KHRG in den Reformkontext der letzten Jahre ein.Since 2003, German hospital reimbursement is totally reorganised. Step by step, a new system based on diagnosis related groups (DRG) is introduced. At the end of the year 2008 transformation should have been completed and there was need to further regulate the post transition period. Therefore a new hospital law (Hospital Financing Reform Act – KHRG) was set off which not only entailed further reimbursement regulation but also a reform of hospital investment financing and measures to improve the tight financial situation of hospitals. As always in hospital legislation, it was hard to reach consensus due to heterogeneous interests of federal government and states. As a result, the new law continues the reform approach of the last years; it does not solve the problems of adequate hospital supply and persistently negates the negative effects associated with the DRGsystem. The discussion paper gives a short overview over the legislative process, presents and discusses the main topics of the KHRG and analyses the new law in the context of former health policy reforms

Politische Steuerung des Gesundheitswesens : die Rolle von Korporatismus und Wettbewerb im Krankenhaussektor

Die politische Steuerung des Krankenhaussektors hat sich in den vergangenen anderthalb Jahrzehnten nachhaltig verändert. Das Gesundheitsstrukturgesetz von 1992 markiert einen gesundheitspolitischen Paradigmenwechsel, mit dem verstärkt wettbewerbliche Steuerungsinstrumente in das Gesundheitswesen eingeführt wurden. Auch im stationären Sektor ersetzen bzw. ergänzen wettbewerbliche Instrumente korporatistische Arrangements. Die Gegenüberstellung der politischen Steuerung des Krankenhaussektors vor 1992 mit der Situation nach der Gesundheitsreform 2007 verdeutlicht, dass auf den Feldern Leistungserbringung, Vergütung und Qualitätssicherung sukzessive ein neues Steuerungsmodell entstanden ist. Dieses zeichnet sich durch eine gewachsene Komplexität, eine Zunahme von Steuerungsaktivitäten und eine Neujustierung des Verhältnisses staatlicher bzw. korporatistischer Steuerung einerseits und wettbewerblicher Steuerung andererseits aus. Dort, wo es um allokative Entscheidungen geht, werden korporatistische Elemente durch wettbewerbliche ersetzt. Auf anderen Regulierungsfelder bleibt der Korporatismus dagegen erhalten. Der Staat als „architect of political order“ (Anderson) hat diese Transformation herbeigeführt, sieht sich allerdings zunehmend mit dem Widerspruch zwischen einer bedarfsorientierten Krankenhausplanung und Investitionsfinanzierung auf Landesebene und einer Leistungsverteilung über den Wettbewerb konfrontiert.In 1993, the Health Care Structure Act (HCSA) introduced several measures that enforced competition in the corporatist German health care system. The HCSA has been widely interpreted as triggering paradigmatic change throughout the system. The most recent Health care reform, the Statutory Health Insurance-Competition Strengthening Act (SHI-CSA) in 2007 continued to strengthen the role of competition in the health care system by adding further regulations and incentives. Comparing the pre-HCSA with the post-SHI-CSA system of hospital governance, the study concludes that a new system of hospital governance has been emerging that shifts the balance from corporatist towards competition-led governance structures. In essence, competition becomes most significant in regulating allocative processes within the hospital sector while corporatism is still the dominant modus operandi in governing remaining functions and subsections. The state as the “architect of political order” (Anderson) has been the driving force of these processes. However, the state is confronted with contradictory forces as well as functions within its realm demanding on the one side the application of a system of hospital planning and investment at state level based on needs and on the other side the consolidation of a competition-led system of allocating funds for services at federal level

Evaluation einer Professionalisierungsmaßnahme für inklusiven Englischunterricht. Unterrichtsplanung und -durchführung vor dem Hintergrund des Universal Design for Learning

Wie können Lehramtsstudierende besser auf ihren Beruf vorbereitet werden? Die explorative Studie befasst sich mit der Entwicklung und Evaluation einer universitären Professionalisierungsmaßnahme im Rahmen des Praxissemesters. Ziel ist es, angehende Lehrkräfte sukzessiv für die Planung und Durchführung von inklusivem Unterricht im Fach Englisch vor dem Hintergrund des Universal Design for Learning (UDL) und eines Planungsleitfadens zu qualifizieren. U.a. zeigt sich eine signifikante Steigerung der studentischen Selbstwirksamkeitserwartungen bezogen auf inklusive Unterrichtsgestaltung. Die Studie leistet einen ersten Beitrag zur Erforschung des Potenzials von inklusionsorientierten Professionalisierungsmaßnahmen vor dem Hintergrund des UDL im Fach Englisch. (DIPF/Orig.

Twenty-ninth Annual Bibliography 2015 (Contemporary German Literature Collection)

The 29th bibliography for 585 volumes added to Washington University Libraries\u27 Contemporary German Literature Collection located on level B of Olin Library. All published in 2015, these acquisitions include novels, poetry, short story collections, essays, autobiographical works, and literary and cultural periodicals from publishers in Germany, Austria, and Switzerland.This Collection serves as the research arm for the Department of Germanic Languages and Literature\u27s Max Kade Center for Contemporary German Literature. A bibliography of items added the previous year is compiled each year by Washington University\u27s Department of Germanic Languages and Literatures in cooperation with the University Libraries

Twenty-eighth Annual Bibliography 2014 (Contemporary German Literature Collection)

The 28th bibliography for 560 volumes added to Washington University Libraries\u27 Contemporary German Literature Collection. All published in 2014, these acquisitions include novels, poetry, short story collections, essays, autobiographical works, and literary and cultural periodicals mainly from publishers in Germany, Austria, and Switzerland. A small number of items published in Italy and Luxembourg were also added. This Collection serves as the research arm for the Department of Germanic Languages and Literature\u27s Max Kade Center for Contemporary German Literature. A bibliography of items added the previous year is compiled each year by Washington University\u27s Department of Germanic Languages and Literatures in cooperation with the University Libraries

Agreement by design: The effect of visual harmony on responses to surveys

The present study is one of the first to empirically examine how the visual harmony of a questionnaire can lead to measurement bias. Researchers often employ questionnaires with Likert scales to measure constructs. In this note, we examine how the design of the survey instrument, specifically, its visual harmony, can impair measurement accuracy. Two studies investigate effects of visual harmony in surveys on responses to Likert scales using paper and pencil surveys. Applying an established customer relationship management model, Study 1 employs a survey of female visitors to a grocery store (n = 115). Switching to a product and brand innovation context, Study 2 employs a survey of male and female members of a consumer panel (n = 180) to examine responses to a new e‐scooter. Across studies, results indicate that assessing important consumer response constructs through visually more harmonious surveys can lead to more positive response patterns, lower scale reliability, and questionable validity, especially with females. Although these effects do not occur uniformly across measures and samples, they occur regardless of consumers' past experience with completing questionnaires, their familiarity with questionnaire design, and the naturalness and elaborateness of the visual design. Relating specific elements (e.g., text boxes, type font, shapes, and images) and relational properties of design (e.g., balance, symmetry, and coherence) to consumers' overall perception of harmony aids marketers and researchers in achieving intermediate levels to obtain realistic, reliable, and valid results

The Northern Calcareous Alps revisited: Formation of a hyperextended margin and mantle exhumation in the Northern Calcareous Alps sector of the Neo-Tethys (Eastern Alps, Austria)

The Neo-Tethys margin evolution is preserved in the Northern Calcareous Alps (Eastern Alps), from Late Permian crustal stretching to Late Triassic oceanization. The Northern Calcareous Alps represent the salt-floored fold-and-thrust belt developed from the salt-influenced Triassic carbonate sedimentary cover of the ancestral European margin of the Neo-Tethys Ocean. A crustal scale model for the margin has been obtained by restoration of regional cross-sections of the Northern Calcareous Alps carbonate platforms. Lithospheric break-up was investigated from remnants of exhumed mantle found within an evaporitic melange, suggesting hyperextended crust underneath the distal Triassic platforms of the Northern Calcareous Alps preceding breakup. By modelling the thermal evolution of the margin in combination with excellent stratigraphic control, a detailed timeline has been established for the evolution of the Neo-Tethys margin, especially around the period of rapid mantle exhumation. Our study indicates that salt-floored carbonate shelfs can be used as a proxy to characterize the margins evolution, from crustal stretching to continental breakup. Diagnostic stratigraphic records are preserved in the carbonate platforms: pre- mantle exhumation carbonates are represented by aggrading isolated carbonate platforms first, followed by expanding and margin wide prograding carbonate shelfs once thermal subsidence dominates. In addition, a distinct clastic sequence is deposited as an immediate response to mantle exhumation, in between the pre- and post-mantle exhumation carbonate factory. Our study proposes a new refined model for the formation of the Neo-Tethys margin and provides new insights for the dynamic coupling of salt-controlled carbonate shelfs and the underlying lithosphere during continental breakup

Epidemiology of common infectious diseases before and during the COVID-19 pandemic in Bavaria, Germany, 2016 to 2021: an analysis of routine surveillance data

Background Unprecedented non-pharmaceutical interventions to control the COVID-19 pandemic also had an effect on other infectious diseases. Aim We aimed to determine their impact on transmission and diagnosis of notifiable diseases other than COVID-19 in Bavaria, Germany, in 2020 and 2021. Methods We compared weekly cases of 15 notifiable infectious diseases recorded in Bavaria between 1 January 2016 and 31 December 2021 in time series analyses, median age and time-to-diagnosis using Wilcoxon rank sum test and hospitalisation rates using univariable logistic regression during three time periods: pre-pandemic (weeks 1 2016–9 2020), pandemic years 1 (weeks 10–52 2020) and 2 (2021). Results Weekly case numbers decreased in pandemic year 1 for all diseases assessed except influenza, Lyme disease and tick-borne encephalitis; markedly for norovirus gastroenteritis (IRR = 0.15; 95% CI: 0.12–0.20) and pertussis (IRR = 0.22; 95% CI: 0.18–0.26). In pandemic year 2, influenza (IRR = 0.04; 95% CI: 0.02–0.09) and pertussis (IRR = 0.11; 95% CI: 0.09–0.14) decreased markedly, but also chickenpox, dengue fever, Haemophilus influenzae invasive infection, hepatitis C, legionellosis, noro- and rotavirus gastroenteritis and salmonellosis. For enterohaemorrhagic Escherichia coli infections, median age decreased in pandemic years 1 and 2 (4 years, interquartile range (IQR): 1–32 and 3 years, IQR: 1–18 vs 11 years, IQR: 2–42); hospitalisation proportions increased in pandemic year 1 (OR = 1.60; 95% CI: 1.08–2.34). Conclusion Reductions for various infectious diseases and changes in case characteristics in 2020 and 2021 indicate reduced transmission of notifiable diseases other than COVID-19 due to interventions and under-detection.Peer Reviewe

Krankenkassen als Partner der kommunalen Gesundheitsförderung und Prävention: Erfolgsbedingungen der Umsetzung des Präventionsgesetzes durch die Kommunen in Nordrhein-Westfalen

Durch das Präventionsgesetz haben sich für die Kommunen neue Möglichkeiten zur Kooperation mit den Krankenkassen im Bereich der Gesundheitsförderung und Prävention ergeben. Ziel des Forschungsprojektes war es, die Erfolgs- und Hinderungsbedingungen dieser Zusammenarbeit zu ermitteln sowie die Steuerungsrolle der Kommunen im Feld der kommunalen Gesundheitsförderung und Prävention zu analysieren. Die hierzu durchgeführte Telefonbefragung der nordrhein-westfälischen Kommunen zeigte sehr heterogene Ausgangsbedingungen bei den Kommunen - insbesondere im Hinblick auf den Grad der Professionalisierung sowie auf die bisherigen Beziehungen zu den Krankenkassen. Die Beziehungen zwischen den Kommunen und Krankenkassen wurden zusätzlich in sechs Fallstudien (drei Städte, drei Kreise) und vier Experteninterviews mit Kassenvertreter_innen vertiefend beleuchtet. In den Fallstudien konnten zudem drei unterschiedliche Steuerungsrollen der Kommunen identifiziert werden.The Prevention Act 2015 created new possibilities for German municipalities to cooperate with the statutory health insurance funds regarding health promotion and disease prevention. The research project aimed at identifying the factors that increase or hinder the chance for this cooperation. Furthermore, the study strived at analyzing the role the municipalities assume in the local governance of health promotion and disease prevention. For these purposes, the authors conducted a telephone survey amongst North Rhine-Westphalian municipalities. The survey revealed a huge diversity amongst municipalities in particular with regard to their degree of professionalism and their previous relationship with health insurance funds. In addition, the authors carried out six case-studies of municipalities and four expert interviews with representatives of health insurance funds to further analyze their relationship. Thus, they also identified three different governance roles amongst municipalities