Result-oriented remuneration for hospital inpatient care

Abstract

Fee-for-benefit means the adjustment of the reimbursement at the quality of care. Both a bonus and a penalty are possible. It is suggested to measure innovative therapies with outcome parameters and give a bonus as an incentive for quality improvements. Standard therapies should be measured with process parameters and be sanctioned with a penalty when the standards are missed. To determine the extend of the bonus and the penalty, the variable costs of a hospital could be used as a reference. Therefore a penalty should not exceed approximately 25 % of the reimbursement. The costs for the introduction and administration of the fee-for-benefit reimbursement must be seen in the context of the necessary improvement of quality insurance in per-case reimbursement with DRG (Diagnosis-Related Groups) in Germany. Related to the incidence of preventable adverse events and the additional costs of poor-quality outcome evaluated from studies fee-for-benefit will be cost-effective by avoiding every sixth adverse event. German legislation allows fee-for-benefit only in small model projects or local integrated networks. It is recommended to allow an optional opening of negotiations between hospitals and sickness funds for fee-for-benefit elements. A pilot study should evaluate the incidence and cost of preventable adverse events in Germany.