Kolb G, Breuninger K, Gronemeyer S, van den Heuvel D, Lübke N, Lüttje D, Wittrich A, Wolff J
Fachbereich Geriatrie und Rehabilitation, Medizinische Klinik St. Bonifatius Hospital, Lingen, Deutschland.
Z Gerontol Geriatr. 2014 Jan;47(1):6-12. doi: 10.1007/s00391-013-0592-7.
Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation.
Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work.
The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.
老年医学作为针对老年人的一种专门治疗形式，由于人口结构变化而变得愈发重要。对于老年医学而言，尤为重要的是将急性护理与维持功能及参与需求相结合。这包括通过康复手段预防对结构化护理的依赖或慢性残疾及障碍。
十年前，德国疾病诊断相关分组（DRG）系统试图将一些程序（如“老年医学早期康复”）纳入医院报销系统。依据结构质量、治疗天数和治疗干预次数定义的OPS 8 - 550.x会触发17种不同的老年DRG，涵盖了大部分医学领域。OPS 8 - 550.x一直在持续修订，以使老年程序的质量方面有清晰的结构。然而，OPS 8 - 550.x是基于已证实的住院治疗需求。在过去十年中，尚未产生同时考虑德国医院系统各方面以及日常工作中的透明度和效益等方面的定义。
德国DRG系统相当好地涵盖了老年医学的基本报销方面；然而，仍然缺乏一个切实可行且以患者为导向的“医院必要性”定义，但这对于合理补偿绝对至关重要。DRG系统中关于老年医学报销的另一个问题是德国各地提供老年住院护理的结构不同。
