Reform of hospital financing: revenue-independent flat rates for acute inpatient obstetrics facilities

Abstract

The patient classification system according to diagnosis related groups (DRGs) is highly related to performance, which was the reason for its national introduction in the early 2000s. Since 2003, hospital services have therefore been remunerated via the DRG system by means of flat rates per case. With few exceptions, all hospital services were remunerated via these flat rates per case until 2019. In 2020, the personnel costs for the nursing staff working in the hospital bed were then covered by the DRG-classified remuneration in order to relieve the enormous economic cost pressure on the nursing staff employed in German hospitals. This pressure is particularly evident in hospital wards with a low proportion of elective procedures (such as obstetrics). The economic management of such hospital wards is challenging. Now an even more far-reaching health policy proposal is being made. According to this proposal, hospitals should be financed for their maintenance costs. This is to be done by means of normatively determined budgets. In this way, a financial relief of the hospitals on the one hand and the promotion of the quality of service provision on the other hand should succeed. In the following paper, the challenges of acute inpatient obstetrics due to the current and planned financing system are examined. For this purpose, six selected experts, who belong to very different levels of care in the hospital sector, give an outlook on the introduction of the reserved financing.