Do Hospitals Respond to Increasing Prices by Supplying Fewer Services?

Medical providers often have a significant influence on treatment decisions which they can use in their own financial interest. Classical models of supplier-induced demand predict that medical providers will supply fewer services if they face increasing prices. We test this prediction based on a reform of hospital financing in Germany. Uniquely, this reform changed the overall level of reimbursement - with increasing prices for some hospitals and decreasing prices for others - without affecting the relative prices for different types of patients. Based on administrative data, we find that hospitals do indeed react to increasing prices by reducing service supply.Anbieter von medizinischen Leistungen treffen häufig Behandlungsentscheidungen für ihre Patienten und haben die Möglichkeit, bei diesen Entscheidungen ihre eigenen finanziellen Interessen zu berücksichtigen. Klassische Modelle der Theorie der 'angebotsinduzierten Nachfrage' prognostizieren, dass medizinische Anbieter auf höhere Preise reagieren, indem sie weniger Leistungen erbringen. Wir testen diese Vorhersage auf Grundlage einer Reform der Krankenhausfinanzierung in Deutschland. Das Besondere an der Finanzierungsreform in Deutschland ist, dass die Reform die Preise für Krankenhäuser verändert hat - mit steigenden Preisen für einige Krankenhäuser und sinkenden Preisen für andere - ohne dabei die relativen Preise für die Behandlung unterschiedlicher Patientengruppen oder unterschiedlicher Krankheiten zu beeinflussen. Unter Nutzung administrativer Daten finden wir, dass Krankenhäuser tatsächlich weniger Leistungen erbringen, wenn die Preise steigen

Pflege-Report 2018

Qualität in der Pflege: Stärken, Schwächen, Perspektiven Der Pflege-Report, der in Buchform und als Open-Access-Publikation erscheint, nimmt jährlich relevante Themen der Versorgung von Pflegebedürftigen unter die Lupe. Schwerpunktthema des Jahres 2018 ist Qualität und Qualitätssicherung in der Langzeitpflege. Dazu werden aktuelle Entwicklungen aufbereitet und kritisch gewürdigt sowie Perspektiven für weitere Entwicklungen aufgezeigt. Die 15 Fachbeiträge erörtern u.a.: theoretische Grundlagen, wissenschaftliche Anforderungen an ein Qualitätsverständnis sowie ethische Fragen; Historie und Weiterentwicklung der gesetzlichen Rahmenbedingungen sowie internationale ordnungspolitische Ansätze zur Steuerung von Qualität; die Perspektive der Nutzer und Herausforderungen bei der Messung von Lebensqualität sowie anreiztheoretische Betrachtungen zu den Wahlentscheidungen der Betroffenen; Wirkungen von Qualifikation und Personalausstattung auf die Qualität der Pflege; Qualität in der ambulanten und stationären Pflege sowie Anforderungen an einen sektorenübergreifenden Zugang zu Qualität. Zudem präsentiert der Pflege-Report Analysen zur Entwicklung der Pflegebedürftigkeit, der Inanspruchnahme verschiedener Pflegeformen sowie der Pflegeinfrastruktur

Weiterentwicklung der gesetzlichen Qualitätssicherung in der Sozialen Pflegeversicherung

Büscher A, Wingenfeld K, Igl G. Weiterentwicklung der gesetzlichen Qualitätssicherung in der Sozialen Pflegeversicherung. In: Jacobs K, Kuhlmey A, Greß S, Klauber J, Schwinger A, eds. Pflege-Report 2018. Qualität in der Pflege. Berlin: Springer; 2018: 37-44

Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study

Background Nationwide, unbiased, and unselected data of hospitalised patients with COVID-19 are scarce. Our aim was to provide a detailed account of case characteristics, resource use, and outcomes of hospitalised patients with COVID-19 in Germany, where the health-care system has not been overwhelmed by the pandemic. Methods In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. To account for comorbidities, we used the Charlson comorbidity index. Findings Of 10 021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18-59 years, 382 [22%] were aged 60-69 years, 535 [31%] were aged 70-79 years, and 388 [23%] were aged >= 80 years). The median age was 72 years (IQR 57-82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199). The most common comorbidities were hypertension (5575 [56%] of 10 021), diabetes (2791 [28%]), cardiac arrhythmia (2699 [27%]), renal failure (2287 [23%]), heart failure (1963 [20%]), and chronic pulmonary disease (1358 [14%]). Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. The Charlson comorbidity index was 0 for 3237 (39%) of 8294 patients without ventilation, but only 374 (22%) of 1727 ventilated patients. The mean duration of ventilation was 13.5 days (SD 12.1). In-hospital mortality was 22% overall (2229 of 10 021), with wide variation between patients without ventilation (1323 [16%] of 8294) and with ventilation (906 [53%] of 1727; 65 [45%] of 145 for non-invasive ventilation only, 70 [50%] of 141 for non-invasive ventilation failure, and 696 [53%] of 1318 for invasive mechanical ventilation). In-hospital mortality in ventilated patients requiring dialysis was 73% (342 of 469). In-hospital mortality for patients with ventilation by age ranged from 28% (117 of 422) in patients aged 18-59 years to 72% (280 of 388) in patients aged 80 years or older. Interpretation In the German health-care system, in which hospital capacities have not been overwhelmed by the COVID-19 pandemic, mortality has been high for patients receiving mechanical ventilation, particularly for patients aged 80 years or older and those requiring dialysis, and has been considerably lower for patients younger than 60 years. Copyright (c) 2020 Elsevier Ltd. All rights reserved