Schwenzer T, Schwenzer C
Frauenklinik Klinikum Dortmund, Dortmund.
Z Geburtshilfe Neonatol. 2010 Oct;214(5):188-97. doi: 10.1055/s-0030-1267212. Epub 2010 Oct 28.
INTRODUCTION Based on the data of the Institut für das Entgeltsystem im Krankenhaus (InEK) cost and revenue data for deliveries in Germany can be compared. The InEK calculates the cost data for each individual diagnosis-related group (DRG) on the basis of those hospitals that deliver their individual cost data, so-called "Kalkulationshäuser". The InEK only publishes data for patients with standard lengths of stay. It does not deliver data for short- and long-stay patients. Beside these cost data, the InEK publishes the nationwide case volume for each DRG. Having a knowledge of the individual base rate (Landesbasisfallwert), which differs from province (Bundesland) to province and, in addition, the nationwide case weight for each DRG, the average revenues for deliveries in general, vaginal deliveries, and Cesarean sections can be calculated. These revenue data differ not only from province to province, but from hospital to hospital because of the individual hospital-specific base rates.
The average costs for a delivery in general, a vaginal delivery, and a Cesarean section were calculated on the basis of the DRG Report Browsers 2005/2007-2007/2009 published by the InEK. The costs for short- and long-stay patients were estimated on the basis of a scenario technique. The revenues were calculated on the basis of the published DRG catalogues, which supply individual case weights, and the county-wide base rate. Short- and long-stay revenues again had to be estimated by a scenario technique. In every DRG the cost data create the basis for the case weight two years later.
In relation to the average base rate over all provinces the 2005 costs are higher than the revenues in each province. Even in Rhineland-Palatinate, the county with the highest base rate, costs and revenues are at par. Only the declining costs from 2005-2007 balance the costs and revenues nationwide. But in provinces with low base rates the revenues stay lower than costs. These data demonstrate the pressure of rationalisation on German perinatal medicine and their hospitals. Cost and revenue comparisons with other countries are of lesser interest. Most countries have totally different systems for financing hospitals. In Germany, the published data show only the running costs financed by public and private health-care insurances. Infrastructure costs are financed by the government. In other countries not only the running costs but also the investment costs must be financed by running revenues too.
引言 基于德国医院报销系统研究所（InEK）的数据，可以对德国分娩的成本和收入数据进行比较。InEK根据那些提供各自成本数据的医院（即所谓的“计算医院”）来计算每个诊断相关分组（DRG）的成本数据。InEK只公布标准住院时长患者的数据，不提供短期和长期住院患者的数据。除了这些成本数据，InEK还公布每个DRG的全国病例数量。了解各联邦州不同的个体基础费率以及每个DRG的全国病例权重后，就可以计算出一般分娩、阴道分娩和剖宫产的平均收入。这些收入数据不仅因联邦州而异，还因各医院特定的个体基础费率而在不同医院间存在差异。
根据InEK发布的《DRG报告浏览器2005/2007 - 2007/2009》计算一般分娩、阴道分娩和剖宫产的平均成本。短期和长期住院患者的成本通过情景技术进行估算。收入根据已发布的提供个体病例权重的DRG目录以及县一级基础费率来计算。短期和长期住院收入同样必须通过情景技术进行估算。在每个DRG中，成本数据为两年后的病例权重奠定基础。
与所有联邦州的平均基础费率相比，2005年各联邦州的成本高于收入。即使在基础费率最高的莱茵兰 - 普法尔茨州，成本和收入也持平。只有2005 - 2007年成本的下降才使全国范围内的成本和收入达到平衡。但在基础费率较低的联邦州，收入仍低于成本。这些数据表明德国围产医学及其医院面临的合理化压力。与其他国家进行成本和收入比较的意义较小。大多数国家的医院融资体系完全不同。在德国，公布的数据仅显示由公共和私人医疗保险资助的运营成本。基础设施成本由政府资助。在其他国家，不仅运营成本，投资成本也必须由运营收入来资助。
