Inpatient care was particularly affected by the upheaval in healthcare. Today the hospitals east and west have adjusted in level.
An inventory after the "Wende “Had quickly shown that the inpatient health and social services in the former GDR lagged far behind the West German standard of care. With considerable financial resources for the renovation of the building, the modernization of medical technology, the reorganization of the administrative structures and the implementation of completely new financing system, we have succeeded in bringing inpatient care into line with that of the old federal states, and sometimes even surpassing it
The rapprochement took place at an astonishingly fast pace and an almost general staff-like implementation of both the state treaty on the creation of monetary and economic system - and Social Union of May 18, 1990 as well as the Unification Treaty of September 24, 1990. The commitment of the State Hospital Associations and the German Hospital Association (DKG) in the mediation of around 500 partnerships between West and East German hospitals also had beneficial effect.
Already in the Unification Treaty, the course was set for the renewal and alignment of inpatient health care in the former GDR on scale of almost one to one. In Article 8 of the Unification Treaty it was specified that the federal legal requirements should be transferred to the accession area. However, and this was clear to the insiders in the hospital system, the alignment and reconciliation could not be achieved quickly. Most of the East German hospitals were largely overwhelmed by the provisions of the Social Security Code (SGB) V on the Hospital Financing Act and the Care Rate Ordinance.
With the appointment of the then Ministerial Director Karl Jung from the Federal Ministry of Labor, special representative was appointed for the establishment of structured health insurance based on the western model and assistance was provided for the establishment and administrative conversion. However, the conversion act could not be initiated without the support of hospital partners from the Federal Republic and unconventional action and aid programs in favor of East German hospitals.
Inpatient care was particularly affected by the upheaval in healthcare. Today the hospitals east and west have adjusted in level.
An inventory after the "Wende “Had quickly shown that the inpatient health and social services in the former GDR lagged far behind the West German standard of care. With considerable financial resources for the renovation of the building, the modernization of medical technology, the reorganization of the administrative structures and the implementation of completely new financing system, we have succeeded in bringing inpatient care into line with that of the old federal states, and sometimes even surpassing it
The rapprochement took place at an astonishingly fast pace and an almost general staff-like implementation of both the state treaty on the creation of monetary and economic system - and Social Union of May 18, 1990 as well as the Unification Treaty of September 24, 1990. The commitment of the State Hospital Associations and the German Hospital Association (DKG) in the mediation of around 500 partnerships between West and East German hospitals also had beneficial effect.
Already in the Unification Treaty, the course was set for the renewal and alignment of inpatient health care in the former GDR on scale of almost one to one. In Article 8 of the Unification Treaty it was specified that the federal legal requirements should be transferred to the accession area. However, and this was clear to the insiders in the hospital system, the alignment and reconciliation could not be achieved quickly. Most of the East German hospitals were largely overwhelmed by the provisions of the Social Security Code (SGB) V on the Hospital Financing Act and the Care Rate Ordinance.
With the appointment of the then Ministerial Director Karl Jung from the Federal Ministry of Labor, special representative was appointed for the establishment of structured health insurance based on the western model and assistance was provided for the establishment and administrative conversion. However, the conversion act could not be initiated without the support of hospital partners from the Federal Republic and unconventional action and aid programs in favor of East German hospitals.
Already at the end of 1989, the districts of Halle and Magdeburg at that time offered help from the Lower Saxony Hospital Society and the Lower Saxony Ministry of Social Affairs to start funding programs, to establish the first hospital companies in the new federal states and to meet the requirements for development and To bring the hospital system of the former GDR into line with the West.
An important driving force for such activities was, for example, the "Inner German Hospital Working Group", which was decided on in spring 1990 at the initiative of the DKG board. As early as mid-May 1990, this body had developed “13 basic positions for future system of hospital care in the GDR”, which formed the guideline for the approximation, alignment and conceptual reorientation of hospital policy in the East. However, when aligning and renewing the care structures, transitional regulations and grace periods were necessary for few more years in order to eliminate the grossest shortcomings of the ailing “socialist achievements” in the GDR hospital system.
The new administrators of the former GDR hospitals were informed and trained by many interested parties, including the DKG and, above all, the industry, so that it can be assumed that the hospitals there already have one after six to eight months They had “congenial” background knowledge in order to stand up to the health insurers with their “secret” strategy paper and to be able to approximately enforce demands for higher remuneration and an appropriate budget.
Off for institutional outpatient clinics
During the transformation process, one had to struggle with another legally determined conversion act and had to adapt: The clinics had to defend themselves against the transition regulations in Section 311 (2) SGB V for outpatient care, according to which church specialist outpatient clinics would end by the end of 1996 at the latest had been fixed. Also because of the considerable resistance of the statutory health insurance physicians, the church specialist outpatient clinics were only allowed to provide outpatient care until December 31, 1995 due to the requirements of the Health Structure Act.
The then Minister for Labor, Social Affairs, Health and Women of the State of Brandenburg, Regine Hildebrandt (SPD), campaigned vehemently for the retention of polyclinic facilities and specialist outpatient departments - but without success.
Already at the end of 1989, the districts of Halle and Magdeburg at that time offered help from the Lower Saxony Hospital Society and the Lower Saxony Ministry of Social Affairs to start funding programs, to establish the first hospital companies in the new federal states and to meet the requirements for development and To bring the hospital system of the former GDR into line with the West.
An important driving force for such activities was, for example, the "Inner German Hospital Working Group", which was decided on in spring 1990 at the initiative of the DKG board. As early as mid-May 1990, this body had developed “13 basic positions for future system of hospital care in the GDR”, which formed the guideline for the approximation, alignment and conceptual reorientation of hospital policy in the East. However, when aligning and renewing the care structures, transitional regulations and grace periods were necessary for few more years in order to eliminate the grossest shortcomings of the ailing “socialist achievements” in the GDR hospital system.
The new administrators of the former GDR hospitals were informed and trained by many interested parties, including the DKG and, above all, the industry, so that it can be assumed that the hospitals there already have one after six to eight months They had “congenial” background knowledge in order to stand up to the health insurers with their “secret” strategy paper and to be able to approximately enforce demands for higher remuneration and an appropriate budget.
Off for institutional outpatient clinics
During the transformation process, one had to struggle with another legally determined conversion act and had to adapt: The clinics had to defend themselves against the transition regulations in Section 311 (2) SGB V for outpatient care, according to which church specialist outpatient clinics would end by the end of 1996 at the latest had been fixed. Also because of the considerable resistance of the statutory health insurance physicians, the church specialist outpatient clinics were only allowed to provide outpatient care until December 31, 1995 due to the requirements of the Health Structure Act.
The then Minister for Labor, Social Affairs, Health and Women of the State of Brandenburg, Regine Hildebrandt (SPD), campaigned vehemently for the retention of polyclinic facilities and specialist outpatient departments - but without success.A significant part of the full inpatient services provided in the former GDR was taken over by growing number of identical and interdisciplinary group practices, and the number of medical care centers had increased steadily from their introduction in 2004 to the end of 2008.
In order to be able to assess the level of convergence and development achieved between East and West in the stationary sector, it is useful to look back at the initial statistics in the year 1989/1990. In the GDR with its nationalized health system there were 540 hospitals with around 165,000 beds, including 72 denominational hospitals with around 11,000 beds. The other hospitals were state sponsored at the time of reunification.
In what was then the old Federal Republic of Germany at the end of 1987, total of 3,071 hospitals with 673,687 beds were available for inpatient care. Of these, around 460,000 beds were operated in 1,781 acute clinics and the remainder in so-called special hospitals, including state psychiatric hospitals, rheumatism clinics, tuberculosis sanatoriums, rehabilitation clinics and others. In the years that followed, the number of beds in both the West and the East continued to decline (see box).
Since 1970, only 20 hospitals with around 15,000 beds have been built or completely restructured in what was then the GDR . Investments were primarily made in the new Charité building and the district hospitals in Cottbus, Frankfurt an der Oder, and Suhl. Prestige and showcase clinics were the government hospitals in Berlin-Buch and, as the central research, training and further education facility, the Charité in East Berlin.
Increasing case numbers in the west and in the east
Both In both western and eastern Germany, the number of inpatient treatment cases - regardless of the gradual reduction in beds - has risen noticeably and steadily before the fall of the Wall. In 1988, 2.7 million cases were counted in hospitals in the GDR; the length of stay was reduced from more than 20 days to 18.1 days. The bed occupancy was around 75 percent at the time of the turnaround. In 1989/90 almost 13 million cases were treated as inpatients in hospitals in Germany; In 1970 there were just under ten million cases. The mean length of stay in acute hospitals was 13.1 days in the old federal states, but almost 46 days in special hospitals. At 86.6 percent, bed utilization in the west was significantly higher than in the east of Germany.A significant part of the full inpatient services provided in the former GDR was taken over by growing number of identical and interdisciplinary group practices, and the number of medical care centers had increased steadily from their introduction in 2004 to the end of 2008.
In order to be able to assess the level of convergence and development achieved between East and West in the stationary sector, it is useful to look back at the initial statistics in the year 1989/1990. In the GDR with its nationalized health system there were 540 hospitals with around 165,000 beds, including 72 denominational hospitals with around 11,000 beds. The other hospitals were state sponsored at the time of reunification.
In what was then the old Federal Republic of Germany at the end of 1987, total of 3,071 hospitals with 673,687 beds were available for inpatient care. Of these, around 460,000 beds were operated in 1,781 acute clinics and the remainder in so-called special hospitals, including state psychiatric hospitals, rheumatism clinics, tuberculosis sanatoriums, rehabilitation clinics and others. In the years that followed, the number of beds in both the West and the East continued to decline (see box).
Since 1970, only 20 hospitals with around 15,000 beds have been built or completely restructured in what was then the GDR . Investments were primarily made in the new Charité building and the district hospitals in Cottbus, Frankfurt an der Oder, and Suhl. Prestige and showcase clinics were the government hospitals in Berlin-Buch and, as the central research, training and further education facility, the Charité in East Berlin.
Increasing case numbers in the west and in the east
Both In both western and eastern Germany, the number of inpatient treatment cases - regardless of the gradual reduction in beds - has risen noticeably and steadily before the fall of the Wall. In 1988, 2.7 million cases were counted in hospitals in the GDR; the length of stay was reduced from more than 20 days to 18.1 days. The bed occupancy was around 75 percent at the time of the turnaround. In 1989/90 almost 13 million cases were treated as inpatients in hospitals in Germany; In 1970 there were just under ten million cases. The mean length of stay in acute hospitals was 13.1 days in the old federal states, but almost 46 days in special hospitals. At 86.6 percent, bed utilization in the west was significantly higher than in the east of Germany.
The federal German hospital system has always been characterized by pluralistic sponsorship of public, non-profit and private hospitals. This has not changed after the creation of the unit. Divided according to the sponsorship, around third of all hospitals are public, non-profit and private sponsors. In terms of the number of beds, however, the public-law clinic operators dominate, accounting for around 50 percent of the beds.
Investment required due to very outdated building fabric
The average age of hospitals in the GDR in 1989 was 60 Years; 64 percent of the building was older than 50 years. The health care system was characterized by long-lasting, chronic underfunding and deficit grievances in health bureaucracy that was governed by planning specifications and central directives and by all executive bodies and actors.
In 1980 the proportion of funds invested in the health and social services of the GDR was only 0.8 percent of the total investment of the economy. This proportion fell to 0.6 percent by the end of the 1980s (around two billion Ostmark). The establishment of new functional units in hospitals (operating theaters, intensive care units, laboratories, diagnostic rooms) and the necessary equipment with modern large devices and smaller technologies were politically recognized as the most pressing problem in the rehabilitation of hospitals in the GDR.
According to rough estimate, the unification's opening balance sheet showed an investment requirement of 25 to 30 billion DM. It was assumed that only five billion DM can be newly invested per year and that this is hardly based on the fact that it is becoming increasingly deficit dual hospital financing could happen in the Federal Republic. It was also undisputed that even smaller investments, which were financed from the care rate in West Germany, would have to be financed in the medium term in the former GDR clinics from tax revenues or would have to be subsidized by the health insurance companies through special funding via the care rate (investment surcharge). This is what happened.
Today, the hospitals in the new federal states consistently have more modern building structure and infrastructure than the partly aging hospitals in the old Federal Republic, which in some cases have only been completely renovated, modernized and expanded were. At the beginning of 2010 there were around 2,018 hospitals nationwide with around 500,000 beds for inpatient care. Compared to 1990 there were 360 fewer hospitals (–15 percent). In the last 20 years, around 180,000 hospital beds have been reduced (–26 percent).
The federal German hospital system has always been characterized by pluralistic sponsorship of public, non-profit and private hospitals. This has not changed after the creation of the unit. Divided according to the sponsorship, around third of all hospitals are public, non-profit and private sponsors. In terms of the number of beds, however, the public-law clinic operators dominate, accounting for around 50 percent of the beds.
Investment required due to very outdated building fabric
The average age of hospitals in the GDR in 1989 was 60 Years; 64 percent of the building was older than 50 years. The health care system was characterized by long-lasting, chronic underfunding and deficit grievances in health bureaucracy that was governed by planning specifications and central directives and by all executive bodies and actors.
In 1980 the proportion of funds invested in the health and social services of the GDR was only 0.8 percent of the total investment of the economy. This proportion fell to 0.6 percent by the end of the 1980s (around two billion Ostmark). The establishment of new functional units in hospitals (operating theaters, intensive care units, laboratories, diagnostic rooms) and the necessary equipment with modern large devices and smaller technologies were politically recognized as the most pressing problem in the rehabilitation of hospitals in the GDR.
According to rough estimate, the unification's opening balance sheet showed an investment requirement of 25 to 30 billion DM. It was assumed that only five billion DM can be newly invested per year and that this is hardly based on the fact that it is becoming increasingly deficit dual hospital financing could happen in the Federal Republic. It was also undisputed that even smaller investments, which were financed from the care rate in West Germany, would have to be financed in the medium term in the former GDR clinics from tax revenues or would have to be subsidized by the health insurance companies through special funding via the care rate (investment surcharge). This is what happened.
Today, the hospitals in the new federal states consistently have more modern building structure and infrastructure than the partly aging hospitals in the old Federal Republic, which in some cases have only been completely renovated, modernized and expanded were. At the beginning of 2010 there were around 2,018 hospitals nationwide with around 500,000 beds for inpatient care. Compared to 1990 there were 360 fewer hospitals (–15 percent). In the last 20 years, around 180,000 hospital beds have been reduced (–26 percent).
In regional comparison, the number of houses in the new federal states fell more sharply (-35 percent) than in the old (-9 percent). In 2007 (last available figures) there were total of 616 acute inpatient hospital beds per 100,000 inhabitants in Germany. In almost all federal states the bed density was between 500 and 700 beds per 100,000 inhabitants, with Bremen as an exception with 819 beds per 100,000 inhabitants. Despite the sharp decline in the number of hospitals and beds in the new federal states, the bed density nationwide is now much more balanced than it was few years ago and at the time of the fall of the Wall.
The innovation and cost pressure in the stationary sector has increased significantly in the last 20 years. Despite initial great resistance, the hospitals had to carry out the most important innovation, namely the conversion of the system of daily care rates in force in the West to diagnosis-related flat rates (diagnosis-related groups), the largest structural reform in the hospital sector in more than 30 years. This increased the pressure for more competitive supply structures. The increasing economization and competitive orientation of the hospital industry can be felt every day in the clinical practice for staff and patients. Even after reunification, the renewal process and innovations in the clinic sector had to be carried out and managed under increasingly difficult financial conditions.
The budgets were and are capped to this day. Even 20 years after reunification, the clinic financing remains tense. The pressure to reduce capacities, to reallocate them and to shorten the length of stay, as well as to substitute full inpatient services with other forms of treatment, is increasing. Due to the increasing severity of the case, however, an increasing length of stay is forecast as well as higher degree of specialization and standardization, further concentration of services and greater concentration on fewer locations and larger carrier units. In east and west.
Dr. rer. pole. Harald Clade
@A long version of the article can be found at www./101204.
Personal comparison East-West
In the Westdeutsche Hospitals employed about 860,000 people in 1988, including about 88,000 doctors (46.3 percent were hospital specialists). One doctor accounted for 7.7 beds. Around 330,000 people were nurses in the West German clinics at the time of the fall of the Wall, plus around 65,000 administrative and roughly 178,000 business professionals and around 47,000 medical-technical employees.
In 1990, around 160,000 people were employed in hospitals in what was then the GDR. This corresponds to an occupancy rate of 0.95 workers per bed.
In regional comparison, the number of houses in the new federal states fell more sharply (-35 percent) than in the old (-9 percent). In 2007 (last available figures) there were total of 616 acute inpatient hospital beds per 100,000 inhabitants in Germany. In almost all federal states the bed density was between 500 and 700 beds per 100,000 inhabitants, with Bremen as an exception with 819 beds per 100,000 inhabitants. Despite the sharp decline in the number of hospitals and beds in the new federal states, the bed density nationwide is now much more balanced than it was few years ago and at the time of the fall of the Wall.
The innovation and cost pressure in the stationary sector has increased significantly in the last 20 years. Despite initial great resistance, the hospitals had to carry out the most important innovation, namely the conversion of the system of daily care rates in force in the West to diagnosis-related flat rates (diagnosis-related groups), the largest structural reform in the hospital sector in more than 30 years. This increased the pressure for more competitive supply structures. The increasing economization and competitive orientation of the hospital industry can be felt every day in the clinical practice for staff and patients. Even after reunification, the renewal process and innovations in the clinic sector had to be carried out and managed under increasingly difficult financial conditions.
The budgets were and are capped to this day. Even 20 years after reunification, the clinic financing remains tense. The pressure to reduce capacities, to reallocate them and to shorten the length of stay, as well as to substitute full inpatient services with other forms of treatment, is increasing. Due to the increasing severity of the case, however, an increasing length of stay is forecast as well as higher degree of specialization and standardization, further concentration of services and greater concentration on fewer locations and larger carrier units. In east and west.
Dr. rer. pole. Harald Clade
@A long version of the article can be found at www./101204.
Personal comparison East-West
In the Westdeutsche Hospitals employed about 860,000 people in 1988, including about 88,000 doctors (46.3 percent were hospital specialists). One doctor accounted for 7.7 beds. Around 330,000 people were nurses in the West German clinics at the time of the fall of the Wall, plus around 65,000 administrative and roughly 178,000 business professionals and around 47,000 medical-technical employees.
In 1990, around 160,000 people were employed in hospitals in what was then the GDR. This corresponds to an occupancy rate of 0.95 workers per bed.The number of clinicians in the GDR hospitals rose noticeably in the last few years before reunification and was around 14,000 in 1989, so that one doctor accounted for twelve beds. Modern diagnostic and therapeutic procedures were only carried out in few selected hospitals; this is especially true for transplant surgery.
Less capacities
In both the Federal Republic of Germany and the GDR, the number of beds in clinics fell steadily in the decades before reunification, as did the number of independent hospital units.
In 1960 there were still 822 hospitals with around 204 767 beds in the GDR, in 1989 there were only 540 clinics with around 165,000 beds.
In 1960 there were still 3 604 hospitals in the old Federal Republic with 583 513 beds available. In 1987 there were only 3,071 hospitals with 673,687 beds.
In 1988, the bed density in the old Federal Republic was 110 beds per 10,000 inhabitants and in acute hospitals 75 beds per 10,000 inhabitants. However, these average values do not reveal the considerable regional and specialist differences in bed density.
4
0
Do you want a website?