TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany.
Health Econ Policy Law. 2020 Jul;15(3):355-369. doi: 10.1017/S1744133119000124. Epub 2019 Jun 4.
Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.
大多数基于诊断相关分组 (DRG) 的医院支付系统为新批准的技术提供支付。在德国，这些支付是由个别医院和健康保险公司之间协商的。我们研究的目的是评估临时报销机制的运作情况。我们使用多水平逻辑回归来检查与医院和州层面相关的因素，这些因素与创新支付的协商有关。因变量是医院是否在 2013 年成功协商了创新支付（n=1532）。使用德国每家医院与健康保险公司代表之间每年预算谈判的协议数据，本研究包括了所有德国急性医院和所有诊断的创新支付。在 2013 年，32.9%的医院成功协商了创新支付。我们发现，如果医院位于竞争激烈的地区，并且规模较大、具有大学地位和私营盈利性实体，那么获得创新支付的机会就会增加。我们的研究表明，接受创新支付的医院存在隐性自我控制选择。虽然这在一定程度上鼓励了患者护理的安全性，但政策制定者应该支持在前瞻性支付系统中更直接和透明的创新支付分配过程。
