德意志联邦共和国的医院融资体系。

Eff Health Care. 1983 Oct;1(3):133-42.

This paper deals with the present hospital financing system of the Federal Republic of Germany. The structure of the financing system is treated as well as the actual financing process, and, as far as possible, both are also quantitatively described. The first section contains a description of the structure, and is concerned with the major institutions participating in the hospital financing system:--the hospitals are described according to ownership, number of beds, specialization, personnel, regional distribution and utilization;--the health insurance system is illustrated by the two major institutions, i.e. statutory and private health insurance agencies, and its effect on hospital financing is explained;--the regulation of the hospital financing system by the federal political system is discussed;--finally, the major economic functions of the institutions involved are summarized; the interrelations of hospital care and the ambulatory sector are also mentioned. The second section contains a detailed description of the actual financing process, which can be classified according to the sections of financing:--the basic system of the German hospital financing law is introduced;--in the section on investment costs, public grants and their allocation, which are closely related to hospital planning, are discussed;--in the section on operating costs, full cost reimbursement as the basic principle, the structure of costs, the elements and the mechanism of operating cost financing, the actual prices, the financing of private patients' care and special services are described;--a short view of accounting balances, i.e. the differences between costs and financing of hospital services which result in profits or deficits, is given. A few considerations on the evaluation of the financing system conclude the paper.

本文论述了德意志联邦共和国目前的医院融资体系。探讨了融资体系的结构以及实际融资过程，并尽可能对两者进行了定量描述。第一部分介绍了结构，涉及参与医院融资体系的主要机构：——按所有权、病床数量、专业化程度、人员、区域分布和利用情况对医院进行了描述；——通过法定和私人医疗保险机构这两个主要机构阐述了医疗保险体系，并解释了其对医院融资的影响；——讨论了联邦政治体系对医院融资体系的监管；——最后总结了相关机构的主要经济职能；还提及了医院护理与门诊部门的相互关系。第二部分详细描述了实际融资过程，可按融资部分进行分类：——介绍了德国医院融资法的基本体系；——在投资成本部分，讨论了与医院规划密切相关的公共补助及其分配；——在运营成本部分，描述了以全额成本报销为基本原则、成本结构、运营成本融资的要素和机制、实际价格、私人患者护理和特殊服务的融资；——简要介绍了会计结余，即医院服务成本与融资之间导致盈利或亏损的差异。本文最后对融资体系的评估进行了一些思考。