Dual financing
The term dual financing or dual hospital financing means that a hospital in Germany has a double financing basis. With the introduction of the Hospital Financing Act (KHG) on January 1, 1972, the legislature decided to split the costs.
Federal states
According to this, the federal states promote hospital investments (basic funding, lump-sum funding, etc.) in accordance with the guidelines on the procedure for granting funding according to Section 9 (1) of the KHG, insofar as they are recorded in a hospital plan. There is a legal right to government funding for investments; for new buildings it is also necessary to be included in a state investment program. In Germany there are large differences in the scope of funding in the individual federal states. The funds are earmarked and are stipulated by the KHG and the state laws to the extent that they cover the investment costs that are eligible for funding and, in compliance with the supply mandate, necessary according to the principles of economy and economy.
Individual funding
With individual funding, the federal states finance long-term investments, which include new buildings or major renovation measures.
Lump-sum funding
The lump-sum funding is based on the number of beds according to the hospital plan and includes minor construction work and the replacement of short-term assets (in Lower Saxony according to NKHG, for example, with an average useful life of more than three and up to 15 years). The respective countries set a value limit. In Lower Saxony, for example, this is 150,000 euros.
With the law on the regulatory framework for hospital financing (Hospital Financing Reform Act - KHRG) of 2009, the lump-sum funding was supplemented by a performance-based investment lump sum. This has been implemented in the federal states' hospital laws since 2011/2012. Since then, the flat-rate funding has been made up of a basic flat rate and a performance flat rate.
Basic flat rate
The basic flat rate is based on the number of beds and day-care places. If necessary, it can be increased if the holding costs are particularly high. Hospitals can also receive an allowance to fund necessary investments for training facilities (e.g. nursing schools) in accordance with Section 2 No. 1 a KHG.
Performance flat rate
The service flat rate is based on the number of inpatients treated (usually according to the diagnosis-related case groups ) and the depreciation of fixed assets in particularly cost-intensive service areas of a clinic.
Statutory health insurance
The statutory health insurance funds finance the ongoing operating costs of the hospitals within the framework of the prescribed hospital remuneration.
Annual budget
Every hospital (possibly supported by the management of a hospital group ) negotiates an annual budget with the health insurance companies to reimburse full inpatient and partial inpatient hospital services. A certain amount of service is agreed for the following year in accordance with the supply contract for a hospital stipulated by the federal state.
The pricing is largely based on the evaluation ratios calculated by the Institute for the Hospital Remuneration System (InEK) for each diagnosis-related case group (DRG) in accordance with the G-DRG system introduced in Germany, which is revised or adapted annually and in an annual agreement for the case flat rate system for hospitals (FPV) . From the number of diagnosis-related case groups (DRG), the case mix (CM) (case severity) is calculated as the sum of the evaluation ratios (cost weights; CW) of the individual hospital. The hospital's annual budget to be calculated for the following year is ultimately calculated by multiplying the case mix with the state base case value (LBFW). The state base rate is set annually in the individual federal states and is different. A nationwide approximately uniform price for hospital services has not yet been achieved.
Revenue compensation
Since the negotiated annual budget relates to hospital services in advance, there are service deviations in the hospitals compared to the agreed service volume. Corresponding additional revenues (through additional services) but also lower revenues (through reduced services) should receive a so-called revenue compensation according to §4 KHEntgG from the health insurance companies in the following year . As a rule, the additional services above the negotiated service volume are only remunerated at a reduced rate.
Exceptions
Hospitals not on the country's hospital plan, e.g. B. Rehabilitation clinics , are only financed through the care rates according to the Federal Care Rate Ordinance (BPflV), which means a monistic hospital financing .
For psychiatric and psychosomatic hospitals, a performance-based and flat-rate remuneration system will also be introduced from 2013. This is initially voluntary and will be mandatory from 2015. The basis is the Psychiatry Remuneration Act (PsychEntgG) passed in 2012. See also: Flat rate remuneration system for psychiatry and psychosomatics (PEPP).
criticism
The statutory health insurances criticize the system for the fact that the federal states can lead to overcapacities through their decisions to promote investments and the running costs have to be covered by the health insurances. In doing so, they also see the influence of political decision-makers in the municipalities, who, similar to the Bundeswehr locations, fear a reduction in the range of services offered by hospitals or their closure, the loss of jobs and a potential economic factor. The municipalities, in turn, argue that even in rural regions, despite a demographic downward trend, citizens must be guaranteed medical care close to home, including through hospitals, and that hospital capacities are generally viewed as a public good .