Neubauer G, Unterhuber H
Eff Health Care. 1985;2(4):161-71.
This paper deals with an economic analysis of the present hospital financing system of the Federal Republic of Germany. In the first section normative criteria for the evaluation of hospital systems are established. The most important objectives are: a medically appropriate hospital care, an efficient production of services and adequate hospital care for everyone. The imminent conflicts between individual and social value systems on the one hand and between allocative and distributive objectives on the other hand are pointed out. The second section contains a short description of the most important elements of a hospital financing system: first the method of coordination of supply and demand. Since pure market systems are rejected as the only mechanism for the coordination of hospital care, other coordination systems must be applied. There are in principle two alternative systems at one's disposal: regulation of the hospital care by public authorities or negotiations between hospitals and financiers. Second, it is analysed how the financial burden can be shared amongst the patient and the various third party financing institutions such as statutory health funds, private insurance companies and public budgets. Third, the modes of reimbursement are discussed. It is pointed out, that besides the problem of how the hospital performance should be measured and how the level of prices of the services should be determined, the distribution of the production risks is the central matter in hospital reimbursement. The more hospitals have to undetake financial risks, the greater the incentives are for an efficient production of services. The third section contains a description of the main failures of the German hospital financing system. It is argued that the central public planning of capacities, which is dominated by political interests, causes excess capacities and structural disequilibria in particular sectors of hospital care. The next important failure is the division of the financial burden amongst public households and statutory health funds in spite of exclusive public planning authority. In the area of reimbursement the total cost reimbursement is criticized. The cost based public investment grants and cost based lump sum per-diem rates per patient in the area of operating cost imply incentives for an inefficient (and ineffective) production of services. The last section deals with some reform proposals which at present are being discussed. All proposals claim a regionalization of the hospital planning and a stronger participation of the hospitals and health funds concerned in the planning process.(ABSTRACT TRUNCATED AT 400 WORDS)
本文探讨了对德意志联邦共和国现行医院融资体系的经济分析。在第一部分中，确立了评估医院体系的规范性标准。最重要的目标是：提供符合医学需求的医院护理、高效地提供服务以及为每个人提供充足的医院护理。指出了一方面个人与社会价值体系之间，另一方面配置性目标与分配性目标之间即将出现的冲突。第二部分简要描述了医院融资体系的最重要要素：首先是供需协调方法。由于纯粹的市场体系被摒弃为协调医院护理的唯一机制，必须采用其他协调体系。原则上有两种可供选择的体系：由公共当局对医院护理进行监管，或者医院与融资方之间进行谈判。其次，分析了如何在患者以及各种第三方融资机构（如法定健康基金、私人保险公司和公共预算）之间分担财务负担。第三，讨论了报销模式。指出除了如何衡量医院绩效以及如何确定服务价格水平的问题外，生产风险的分配是医院报销的核心问题。医院承担的财务风险越大，对高效提供服务的激励就越大。第三部分描述了德国医院融资体系的主要缺陷。有人认为，由政治利益主导的中央公共能力规划导致了医院护理特定领域的产能过剩和结构失衡。下一个重要缺陷是，尽管拥有独家公共规划权，但公共家庭和法定健康基金之间仍存在财务负担划分问题。在报销方面，总成本报销受到批评。基于成本的公共投资补助以及运营成本领域基于成本的每位患者每日包干费率意味着对低效（且无效）服务生产的激励。最后一部分讨论了目前正在讨论的一些改革建议。所有建议都主张对医院规划进行区域化，并让相关医院和健康基金更多地参与规划过程。（摘要截选至400字）
