Nierhoff G
St.-Johannes-Hospital Dortmund.
Zentralbl Chir. 1995;120(7):517-23.
The 'Gesundheitsstrukturgesetz 1993' (GSG 1993) and the following law has resp. will considerably change the hospital scene. Thus the intended cost reduction in the hospital sector ought to be reached by the following measures: abolition of covering cost prices a more sufficient connection of in- and outdoor-patient treatments fixed budgets for 1993/1994 and resp. 1995 adoption of a differentiated system of fees a growing quota of the head physicians' charges for the sick-insurances In this context the abolition of covering cost prices is a minor problem. A more significant subject in consideration of the increasing requirements of hospital management is the organizational realization of the following aspects: rising forms of operating on outdoor-patients, pre- and post-indoor treatments, the period of fixed budgets in 1993/1994, resp. to 1995, as well as the calculation of the various fees. In addition to that the reduced revenues from the charges of head physicians pose a problem for the hospitals. The adoption of the new forms of treatment causes serious changes in both the functional and the proceeding organization of hospitals. The period of fixed budgets is of disadvantage in particular for those hospitals which did not manage to agree upon 'Fallpauschalen' and 'Sonderentgelte' until 1992 under the law of 1986 (Bundespflegesatzverordnung 1986). These prices or fees are not subject of the fixed budgets. Thus only hospitals having agreed upon these prices have the chance to raise their budget in case of an increased number of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
1993年的《卫生结构法》(GSG 1993)及后续法律分别或将会极大地改变医院格局。因此,医院部门预期的成本削减应通过以下措施实现:取消成本覆盖价格;加强门诊与住院治疗之间更充分的衔接;确定1993/1994年及1995年的固定预算;采用差异化收费系统;增加主治医师收费中由医疗保险承担的份额。在此背景下,取消成本覆盖价格是个小问题。考虑到医院管理要求不断提高,一个更重要的问题是如何在组织层面实现以下方面:门诊手术形式增多、住院前后治疗、1993/1994年及1995年固定预算期,以及各种费用的计算。此外,主治医师收费收入减少给医院带来了问题。采用新的治疗形式会给医院的功能组织和流程组织带来重大变化。固定预算期尤其对那些在1986年法律(《联邦护理费率条例1986》)下直到1992年都未能就“病例包干费”和“特殊费用”达成一致的医院不利。这些价格或费用不在固定预算范围内。因此,只有那些就这些价格达成一致的医院才有机会在患者数量增加时提高预算。(摘要截选至250词)