Riessen Reimer, Markewitz Andreas, Grigoleit Maja, Karagiannidis Christian, Waydhas Christian, van den Hooven Thomas, Hermes Carsten, John Stefan, Burchardi Hilmar, Möckel Martin, Janssens Uwe, Dennler Ulf
Internistische Intensivstation, Universitätsklinikum Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Deutschland.
, Am Goldberg 24, 56170, Bendorf, Deutschland.
Med Klin Intensivmed Notfmed. 2020 Feb;115(1):59-66. doi: 10.1007/s00063-019-00629-3.
In Germany, there are currently many voices calling for a reform of hospital planning and reimbursement to correct some aberrations of the last decades and to enable the system to cope with future challenges. Some recent political decisions to change the structures of emergency medical services as well as the introduction of mandatory nurse-to-patient ratios and the exclusion of the cost for nursing from the case-based hospital reimbursement represent first steps of a reform, which also affects intensive care and emergency medicine. In this discussion paper a group of intensivists, emergency physicians, medical controllers, and representatives of nurses suggest more far-reaching changes, which can be summarized in 5 points: (1) General hospitals with intensive care units (ICU) and emergency departments (ED) which are part of the emergency medical system should be considered as an element of public service and be planned accordingly. (2) The planning of the intensive care infrastructure should be based on the three levels of emergency medical services to identify hospitals that are system relevant and to define appropriate criteria for structure and quality measures. (3) Hospital reimbursement should consist of a base amount (covering costs for hospital staff, infrastructure plus investments) and case-based fees (covering material costs). (4) To determine the requirements for nurses, physicians, and other medical staff, adequate tools for ICU and ED should be applied. (5) For these purposes as well as for quality management and optimal medical care, hospitals should be provided with a substantially improved IT-infrastructure.
在德国，目前有许多声音呼吁对医院规划和报销制度进行改革，以纠正过去几十年出现的一些偏差，并使该系统能够应对未来的挑战。最近一些改变紧急医疗服务结构的政治决定，以及引入强制性护士与患者配比，以及将护理费用排除在按病例计算的医院报销范围之外，这些都是改革的第一步，也影响到重症监护和急诊医学。在这篇讨论文件中，一组重症监护医生、急诊医生、医疗管理人员和护士代表提出了更具深远意义的变革，可概括为五点：（1）作为紧急医疗系统一部分的设有重症监护病房（ICU）和急诊科（ED）的综合医院应被视为公共服务的一个要素，并据此进行规划。（2）重症监护基础设施的规划应基于紧急医疗服务的三个层面，以确定与系统相关的医院，并为结构和质量措施定义适当的标准。（3）医院报销应包括基本金额（涵盖医院工作人员、基础设施及投资成本）和按病例计算的费用（涵盖材料成本）。（4）为确定护士、医生和其他医务人员的需求，应采用适用于ICU和ED的适当工具。（5）为实现这些目标以及进行质量管理和提供最佳医疗服务，应大幅改善医院的信息技术基础设施。
