Medizinethische Aspekte der fallpauschalisierten Abrechnung im deutschen Krankenhauswesen

Abstract

Since 2004 there is a new reimbursement system in German hospitals called DRGs (diagnosis related groups). This thesis deals with changes in the quality of treatment of patients with lung-cancer and resulting ethical problems caused by DRGs. Therefore we contacted patients with lung-cancer and conducted a questionnaire study for their hospital stay which took place in the years from 2003 to 2005. Additionally, we interviewed the treating physicians and nurses. Statistic information about the hospital stay and the treatment conditions of this patient group were surveyed from the data of the Dept. for Data Controlling of the University Medical Center Göttingen. The aims of this project were the ethical evaluation and documentation of the changes in the organisation of the hospital stay and the medical treatment of patients with lung cancer due to the introduction of DRGs. Because of a comparably low response rate, the empirical results of the questionnare study cannot be generalized for the whole group of patients with lung-cancer. An ethical analysis of the empirical outcomes were carried out according to the approach of Beauchamp & Childress for the principles of non-maleficience and justice We created reasearch questions about the quality of treatment, the quality of live, the demand of care and the individual support. In addition, we examined the freedom of therapy for the treating physicians and the lethality of patients with lung-cancer during their hospital stay. We also examined whether people living in the countryside are disadvantaged by structural changes that are caused by the introduction of DRGs. In this thesis we discovered and documented that the quality and the outcomes of treatment after the implementation of DRGs is comparable and not worse than the situation before the introduction of DRGs. The same applies for the patient s quality of life. According to the majority of the surveyed patients, there is no additional need for care and support after the introduction of DRGs in comparison to the situation before. It could also not be shown that patients from the countryside are discriminated by the implementation of DRGs and following concentration processes in the supply of health care. The majority of physicians remarked that there is still a sufficient degree of freedom in the choice of an individual therapy. In contrast, physicians critically remarked that they have less time for dialogue with their patients, but they, equally as the nurses, try to compensate this situation. Finally, the lethality of patients with lung cancer in the University Medical Center decreased, which could be caused by a change of the place of death due to a shortened duration of stay after the implementation of DRGs. Following the chapter with the presentation of the empirical data comes a chapter for the discussion of results in matters of the ethical principals of non-maleficience and justice. We conclude that the introduction of DRGs in Germany is compatible with both ethical principles, but that it is furthermore important to observe the development of DRGs in due consideration of these principles.