Berlin - Union and SPD want to pay better hospitals than bad ones in the future. For this, instruments must be found with which good quality can be reliably measured. But is that even possible?
Pro - Georg Rüter: Clear commitment to transparency and willingness to improve
, that the quality in German hospitals has steadily to continuously improved. From the statements of the central associations of the health insurance companies one has to get the impression that sometimes scandalous conditions prevail, which call for bans and restrictive legislative interventions. While the health insurances have so far addressed the quality issue quite aggressively, the pay-for-performance symposium of Qualitätskliniken.de and the policy paper of the National Association of Statutory Health Insurance Funds registered more backward-looking positions that even call for staff numbers.
Essentially, it is about the further development of the DRG system, which has proven its effectiveness: We have never seen such high level of transparency in hospital services; and the unit price has sanctioned well-established hospitals as well as underorganized hospitals since 2010. Now the question arises: Do we want an input orientation or do we want to dare an output and thus quality orientation?
Many German hospitals are happy to offer quality-oriented price differentiation. They would like to initiate pilot projects with the health insurance companies, test and demonstrate quality indicators. Opening clauses for corresponding pay negotiations would be very welcome. With such steps, the issue of quality would receive more impetus than with endless discussion loops about risk adjustment or other highly scientifically justified fundamental objections. A clear sign of commitment to transparency and willingness to improve would also be set towards the patient.
Cons - Alfred Dänzer: There can be no discounts on the quality of hospital medicine strong>
Surcharges and deductions linked to the quality of treatment for the services provided are not suitable means of increasing the quality of treatment in the clinics. On the contrary: discounts are suitable to be reinterpreted as discounts and thus to set incentives for lower quality. As result, only the health insurance company would win. Because discounts always mean savings for the cost bearers.
In technical terms, link between remuneration and quality would have to be determined as follows: as valid evidence that individual service providers significantly undercut the absolute reference ranges, which would be classified as relevant for the treatment not only statistically but also in reality.However, there are no sufficiently precise instruments for measuring the quality of results. Due to the cross-sectoral quality assurance that has not yet been implemented, many patient-relevant endpoints are not yet accessible for quality assurance because they cannot be recorded during the inpatient stay to be assessed.
Also the sole increase in Selectivity of individual indicators, for example by considering several years of treatment together, would not be sufficient as solution. If the increase in the number of cases significantly undershoots reference range, this is not yet evidence of the relevance of this result. In other words: Because of all the statistics trimmed to discount patient care, the human being in the patient could fall by the wayside.
Experience, for example in the USA, has shown that pay-for-performance programs are not significant Quality change resulted. The hospitals are therefore confident that the quality reporting with the newly founded quality institute will be placed on scientifically sound basis.
Union and the SPD want to pay better hospitals than bad ones in the future. For this, instruments must be found with which good quality can be reliably measured. But is that even possible? A new task for the G-BA The discussion about pay for performance models is not new.