[Result-oriented remuneration for hospital inpatient care]

Area of Science:

• Health Economics
• Healthcare Quality Management
• Health Services Research

Background:

• Current healthcare reimbursement systems, particularly Diagnosis-Related Groups (DRG) in Germany, necessitate improved quality assurance.
• Fee-for-benefit models offer a mechanism to link reimbursement directly to the quality of care provided.

Purpose of the Study:

• To propose a fee-for-benefit reimbursement model for healthcare in Germany.
• To outline methods for incentivizing quality improvements and penalizing substandard care.

Main Methods:

• Utilizing outcome parameters for innovative therapies and process parameters for standard therapies.
• Suggesting variable hospital costs as a reference for bonus/penalty determination, with penalties capped at approximately 25% of reimbursement.
• Estimating cost-effectiveness based on the incidence of preventable adverse events and associated costs.

Main Results:

• Fee-for-benefit can incentivize quality improvements through bonuses for innovative therapies and penalties for standard therapies missing quality benchmarks.
• The model is projected to be cost-effective, potentially avoiding one in six adverse events.
• Current German legislation restricts fee-for-benefit to pilot projects, necessitating policy adjustments.

Conclusions:

• Implementing fee-for-benefit reimbursement can enhance healthcare quality and potentially reduce costs by minimizing adverse events.
• Recommends optional negotiations between hospitals and sickness funds for fee-for-benefit elements.
• Advocates for a pilot study to assess the incidence and cost of preventable adverse events in Germany.