Schwarz Julian, Heinze Martin, Holzke Martin, Klär Andreas, Löhr Michael, Schaffert Reinhard, Wolff Jan
Hochschulklinik für Psychiatrie und Psychotherapie der Medizinischen Hochschule Brandenburg, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Deutschland.
Klinik für Psychiatrie und Psychotherapie Weissenau, ZfP Südwürttemberg, Weingartshofer Straße 2, 88214, Ravensburg, Deutschland.
Nervenarzt. 2022 Jan;93(1):34-40. doi: 10.1007/s00115-021-01088-y. Epub 2021 Mar 19.
Nursing staff were excluded from the German DRG system for somatic hospital treatment and will be funded separately in the future. In psychiatry and psychosomatic medicine, binding personnel requirements have been defined but there has been no regulation of how these personnel requirements are adequately financed.
The objective of this study was to analyze the costs of inpatient psychiatry and psychosomatic medicine and to evaluate possible effects of funding nursing staff separately.
This analysis is based on aggregated daily treatment costs of selected hospitals (data year 2018), which annually submit their performance and cost data to the Institute for the Hospital Remuneration System (InEK) for the empirical further development of the remuneration system.
Nursing staff represent the largest cost factor in inpatient psychiatry and psychosomatic medicine. Excluding nursing staff drastically reduces the variance of psychiatric DRG renumeration and even exceeds its proportion of the total costs. After outsourcing nursing costs, psychiatric DRGs achieve only a very limited cost separation.
The binding personnel requirements necessitate adequate financing of nursing staff. This raises the debate about the further development of psychiatric remuneration. The question arises as to whether the effort associated with using the psychiatric DRG system justifies its usefulness as an instrument for budgeting when core functions such as cost separation are only given to a limited extent. Alternative approaches to budgeting should also be examined for putting costs and benefits in a better ratio.
德国躯体疾病住院治疗的疾病诊断相关分组（DRG）系统将护理人员排除在外，未来将对其进行单独资助。在精神病学和身心医学领域，已经确定了具有约束力的人员配备要求，但对于如何为这些人员配备要求提供充足资金尚无相关规定。
本研究的目的是分析住院精神病学和身心医学的成本，并评估单独资助护理人员可能产生的影响。
本分析基于选定医院的每日汇总治疗成本（数据年份为2018年），这些医院每年向医院薪酬系统研究所（InEK）提交其绩效和成本数据，以用于薪酬系统的实证进一步发展。
护理人员是住院精神病学和身心医学中最大的成本因素。排除护理人员会大幅降低精神科DRG薪酬的差异，甚至超过其在总成本中的比例。将护理成本外包后，精神科DRG实现的成本分离非常有限。
具有约束力的人员配备要求需要为护理人员提供充足资金。这引发了关于精神科薪酬进一步发展的争论。问题在于，当成本分离等核心功能仅在有限程度上具备时，使用精神科DRG系统所付出的努力是否足以证明其作为预算工具的有用性。还应研究替代的预算方法，以使成本与效益的比例更合理。
