Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.
University of Applied Sciences Munich, Hohenzollernstr. 102, 80796, Munich, Germany.
BMC Health Serv Res. 2024 Mar 7;24(1):310. doi: 10.1186/s12913-024-10748-z.
Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors.
We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants.
The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness.
This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel.
德国是欧盟成员国中人均医疗保健支出最高的国家，但由于政府取消了投资成本覆盖，其医院面临着独立盈利的压力。为了解决成本问题，引入了按疾病诊断相关分组（DRG）支付系统，这对医院医生提出了在预先设定的价格和经济目标范围内提供服务的挑战，以降低成本。本研究考察了德国医院医务人员成本意识的程度及其影响因素。
我们开发了一个在线调查，让医院各科室的参与者估算四种常见干预措施的欧元价格，并回答有关人力资本和工作场所感知压力的问题。我们将正确估计价格的概率作为成本意识的衡量标准。我们在 86 名参与者的样本中使用对数逻辑回归估计器来确定影响因素。
结果表明，大多数受访者对常见干预措施的成本一无所知。一般人力资本，通过先前的教育获得，以及特定于工作的人力资本对成本意识没有影响，而特定于领域的人力资本，即基于自身利益获得经济知识，对成本意识有积极的非线性影响。此外，压力水平的增加会对成本意识产生负面影响。
本文是德国医疗保健行业中首例针对德国医院的医疗保健专业人员是否具有成本意识的研究，并探讨了缺乏这种知识的原因。我们的研究结果表明，引入 DRG 系统所期望的成本意识尚未被医务人员所实现。
