hospital

from Wikipedia, the free encyclopedia
View of the ward block of the Berlin University Hospital Charité (Campus Mitte) from the roof of the Reichstag
The University Hospital Aachen is one of the largest hospital buildings in Europe.
The district hospital in Chemnitz
The Augsburg Clinic has the highest air rescue station in Germany.

A hospital (as an organizational sub-area also clinic or clinic ) is a medical facility. There, medical and nursing help diagnose illnesses , ailments or physical damage and treat them to heal or alleviate them. The obstetrics and palliative care are among the tasks of a hospital.

From a legal point of view, a hospital in Germany is understood to mean an operation within the meaning of the Hospital Financing Act (KHG) in which the people to be cared for can be accommodated and fed.

Terms used synonymously are also hospital , in Austria and Switzerland also hospital . A military hospital is a hospital called.

History of the hospital

The tasks of a hospital have changed over time. Medicine was originally closely linked to religion. The temples of ancient Egypt were also used to treat the sick. The first independent institutions that looked after the sick are known from Sri Lanka and later also from India . The first teaching hospitals arose in ancient Persia .

Under Borsuye, who also worked as chief physician of the Royal Hospital under Chosrau I , there were the first departments separated according to clinical pictures in the 6th century AD.

In the early Middle Ages, hospitals emerged especially in larger cities in the Arab-Islamic dominated world, whose scholars and doctors were already developing drugs and performing operations at a comparatively high level. As the capital of the Abassid Empire, Baghdad alone had around a hundred clinics in the 11th century.

In the European Middle Ages , a "hospital" also served as a poor house or shelter for pilgrims . The term hospital used at the time is derived from the Latin hospitalis ('hospitable') from the Latin word hospes for "guest, stranger". Most of the care was provided by monks or nuns , for example in the Hôtel-Dieu . The first modern hospitals appeared in the 18th century. The Charité was founded as a plague hospital in 1710 .

Since general hospitals were founded (e.g. in Vienna around 1780), the hospitals have become less and less a place of care for the poor, but rather a place of intensive medical diagnosis and therapy , as well as a place of teaching and training.

In the course of the 20th century, and especially after the Second World War , an economic penetration of the hospital system began, which changed the way hospital services were provided very comprehensively and permanently. Starting from the USA, market and competition mechanisms in the hospital sectors of almost all industrialized countries gained massive importance, which ultimately led to an "industrialization of the hospital system" that has continued to this day, the effects of which on society as a whole still cannot be conclusively assessed.

Tasks of a hospital

The rescue chain

The modern hospital is a service provider in the healthcare sector . Its tasks are to offer the sick, suffering and help-seeking people diagnostics , therapy and care for the purpose of medical rehabilitation or appropriate palliative support in the event of incurable illness. This task is known as hospital treatment and includes the following areas:

  • Emergency treatment
  • inpatient and partial inpatient treatments
  • pre-hospital and post-hospital treatments
  • outpatient treatment
  • rehabilitative treatment

As university clinics, hospitals are often also a center of teaching and research .

The term specialist clinic is used to refer to hospitals that focus on limited, but often highly specialized, inpatient health services. For Germany, the following applies: only if a specialist clinic is included in the hospital plan of a federal state is it a specialist hospital.

Since in addition to nursing care, hospitals always guarantee medical care around the clock, so they also offer emergency medical care, mostly via a rescue center or a central emergency room, ambulance or polyclinic . The equipment and personnel capacity for this type of emergency care vary widely. Specialized trauma centers, for example, offer better care based on equipment and exercise. Several studies show that the higher the number of cases, the higher the quality of care.

In addition to emergency care, the number of cases is also increasingly being considered for planned interventions, and centers with specialized diagnostics are being set up (e.g. breast centers).

At the end of a hospital stay, considerations about aftercare must be made. With care transfer , the organization and coordination of home care and care of the discharged patients by employees of the clinic and the social stations is named. Possibly. This is followed by a home admission for permanent inpatient care (= nursing home or similar). Another specialty is the bridge maintenance for oncological patients in their home environment by the clinic staff.

classification

An acute hospital or an acute clinic is understood to be a hospital in which acutely ill patients are treated as inpatients or outpatients and are available day and night. The supplement to the acute sector are the rehabilitation clinics - clinics, medical rehabilitation, aftercare and follow-up treatment (AHB) perform.

Hospitals can be further classified according to the number of patients, the number of (planned) beds, the provider or the focus of their activity.

The classification according to the hospital operator differentiates between public, non-profit and private carriers. Public sponsors are, for example, federal states, districts and cities, non-profit organizations, for example, the churches or the Red Cross. According to the German Hospital Association , 29.5% of 1,956 clinics in Germany were operated by public institutions, 34.7% by non-profit institutions and 35.8% by private companies in 2015. Public institutions now mostly operate their hospitals under private law: 60.1% of public clinics are run in the legal form of a GmbH or AG . The formerly dominant legal form of a legally dependent institution ( government or self-propelled ) with a share of 16.5% of all public hospitals only of secondary importance.

In state hospital planning , healthcare provision was divided into care levels (deleted Section 23 Hospital Financing Act):

Most federal states today, however, forego the division of hospitals into care levels in their hospital laws.

Hospital statistics Germany

In Germany there are (data for 2015) 1,956 hospitals with a total of 499,351 beds, in which more than 19.2 million cases are treated by more than 1.19 million employees, including 174,391 doctors. This means that 6.1 beds are available for every 1,000 residents. On average, a hospital has 255 beds.

The average length of stay of German patients in general hospitals has decreased from around 14 days in 1991 to 7.3 days (2015), while the number of hospital cases increased from 1,822 cases per 10,000 inhabitants to 2,355 cases per 10,000 inhabitants in the same period . The decreasing length of stay is partly due to new diagnostic, therapeutic and surgical procedures. Another fundamental cause of the upheaval in hospital care are the changes in hospital financing; diagnosis-related flat-rate fees create incentives for a stay as short as possible (although a decreasing length of stay is not an automatic health-political success indicator, leading to early discharges, in addition to the risk for the patient Additional costs because of the frequent need to treat the disease again). It should be noted that the average length of stay differs greatly depending on the specialist department: the spectrum ranges from 2.9 days in ophthalmology to 42.2 days in psychotherapeutic medicine / psychosomatics .

In the period since 1991, the number of hospitals has decreased from 2,411 to 1,956 (2015). At the same time, the share of public institutions fell sharply (from 46% to 29.5%). As part of a continuous reduction in capacity, beds were also reduced from 1990 to 2015, starting from 685,976 in 1990 to around 499,351 beds. In 2007 around 20 out of 100 residents were treated in a German hospital each year.

The bed occupancy fell significantly from 1991 (84.5%) to 2003 and has remained relatively constant since then. In 2015, the rate was 77.5 percent.

Support of the hospitals since 1966
heading public Public swimming
profit		 private-
economic		 total
Hospitals 2015 577 679 700 1.956
Hospitals 2013 596 706 693 1.995
Hospitals 2012 601 719 697 2.017
Hospitals 2010 630 755 679 2,064
Hospitals 1991 1.109 944 358 2.411
Hospitals 1966 1,366 1,291 978 3,635
Beds 2015 240,653 167,566 91.132 499.351
Beds 2013 240,541 170,095 89,949 500,585
Beds 2012 240.275 171.170 90.044 501,489
Beds 2010 244.254 173.457 85.038 502.749
Beds 1991 297.731 200,859 48.710 547,300
Beds 1966 352,603 233,651 54,118 640.372

* Data from 1966 only West Germany including West Berlin.

The following values ​​on the number of facilities, beds and patient movements between 1991 and 2015 were collected by the Federal Statistical Office . The figures for 1971 come from the Fischer Weltalmanach 1973.

year health
houses 		beds Number of cases
in 1000 		Occupancy days
in 1000 		Average
length of stay
in days 		Average
bed occupancy
in percent
1966 * 3,635 640.372 k. A. k. A. 19.5 k. A.
1971 * 3,545 690.236 k. A. k. A. 17.3 k. A.
1991 2.411 665,565 14,577 204.204 14.0 84.1
1992 2,381 646.995 14,975 198,769 13.2 83.9
1993 2,354 628,658 15.191 190.741 12.5 83.1
1994 2,337 618.176 15,498 186.049 11.9 82.5
1995 2,325 609.123 15,931 182,627 11.4 82.1
1996 2,269 593.743 16,165 175.247 10.8 80.6
1997 2,258 580.425 16,429 171,837 10.4 81.1
1998 2.263 571,629 16,847 171,802 10.1 82.3
1999 2,252 565.268 17.093 169,696 9.9 82.2
2000 2,242 559,651 17,263 167,789 9.7 81.9
2001 2,240 552,680 17,325 163,536 9.4 81.1
2002 2,221 547.284 17,432 159.904 9.2 80.1
2003 2,197 541.901 17,296 153,518 8.9 77.6
2004 2,166 531.333 16.802 146,746 8.7 75.5
2005 2.139 523.824 16,539 143.244 8.7 74.9
2006 2,104 510.767 16,833 142,251 8.5 76.3
2007 2,087 506.954 17.179 142,893 8.3 77.2
2008 2,083 503.360 17,520 142,535 8.1 77.4
2009 2,084 503.341 17,817 142.414 8.0 77.5
2010 2,064 502.749 18,033 141,942 7.9 77.4
2011 2,045 502.029 18,343 141,676 7.7 77.3
2012 2.017 501,475 18,620 142.024 7.6 77.4
2013 1.995 500,671 18,787 141,340 7.5 77.3
2014 1,980 500,680 19,149 141,534 7.4 77.4
2015 1.956 499.351 19,239 141.281 7.3 77.5

* = Data only for West Germany and West Berlin

Data for the individual federal states 2011
Year / state health
houses 		beds Number of cases
in 1000 		Occupancy days
in 1000 		Average
length of stay
in days 		Average
bed occupancy
in percent
Baden-Württemberg 285 56,910 2,095 19,120 7.8 77.1
Bavaria 370 75,827 2,812 22,378 7.5 76.7
Berlin 79 19,905 771 5,981 7.8 82.3
Brandenburg 53 15.210 545 4,425 8.1 79.5
Bremen 14th 5.134 203 1,467 7.3 78.3
Hamburg 47 12,071 461 3,659 7.9 83.0
Hesse 174 35,941 1,299 10,067 7.7 76.7
Mecklenburg-Western Pomerania 39 10,375 410 2,987 7.3 78.9
Lower Saxony 197 42.204 1,616 12,353 7.6 80.2
North Rhine-Westphalia 401 121,556 4,286 33,534 7.8 75.6
Rhineland-Palatinate 95 25,375 891 6,752 7.6 72.9
Saarland 23 6,451 267 2,045 7.7 86.9
Saxony 80 26,467 986 7,649 7.8 79.2
Saxony-Anhalt 49 16,388 591 4,498 7.6 75.2
Schleswig-Holstein 94 15,990 581 4,505 7.8 77.2
Thuringia 45 16,193 569 4,526 8.0 76.6
USA
2001 		Australia
2000 		Sweden
2000 		Germany
2004
Acute beds
per 1000 inh. 		2.9 3.8 3.2 5.7
Length of stay
in days 		5.8 6.1 5 8.7
Hospital cases
per 1000 inh. 		112.4 157.7 162.6 191.6

In Germany, the number of beds is relatively high compared to other countries. There is a continuous trend towards reducing beds. The German figures are also comparatively high for the induction rate and length of stay , although the length of stay in Germany has decreased significantly in recent years (see table and the causes above). This is due to the different structure of the health system in the various countries. The costs per case are rather below average in Germany, which can be explained on the one hand by the rather low staffing levels and on the other hand by the distribution of the costs over many cases. 10.8 hospital employees per 1,000 inhabitants ensure inpatient care in Germany, while in Austria 15.3, Ireland 14.9 and Italy 12.3 employees per 1,000 inhabitants work in inpatient care. The US has the highest number of hospital staff with a value of 16.1.

In 2005, hospital costs per case in Germany averaged $ 5,478 per patient, while the United States spent $ 13,452, Luxembourg $ 11,640, Canada $ 10,334, Italy $ 6,803, and Sweden $ 5,674.

The 20 most common main diagnoses in fully inpatients

The information applies to Germany 2009 with ICD code and absolute case numbers.

ICD-10 Diagnosis reason for
treatment		 total of which
male		 of which
female
Z38 Live births including healthy newborns 459.315 230,510 228.805
I50 Heart failure 363,662 171,870 191,792
F10 Mental and behavioral disorders due to alcohol 339.092 249,250 89,842
I20 Angina pectoris (heart pain) 260.505 165.838 94,667
S06 Intracranial Injury (Traumatic Brain Injury) 240,576 132,929 107,647
I48 Atrial flutter and atrial fibrillation 231,686 121,100 110,586
I63 Ischemic stroke (cerebral infarction) 226,581 110.222 116,359
J18 Pneumonia (inflammation of the lungs), pathogen unspecified 221,356 121,960 99,404
K80 Cholelithiasis (gallstone) 213,680 74,359 139,321
I21 Acute myocardial infarction (heart attack) 207,691 132,428 75.263
M17 Gonarthrosis (knee osteoarthritis) 205,659 73.964 131,695
I10 Essential (primary) hypertension (high blood pressure) 199.096 64,099 134.997
I25 Chronic ischemic heart disease (coronary arteries) 192.452 139.202 53,250
C34 Malignant growth of the bronchi and lungs (lung cancer) 188.081 127.985 60.096
J44 Other chronic obstructive pulmonary disease 185.396 104,706 80,690
E11 Non-primarily insulin-dependent diabetes mellitus (type II diabetes) 171,299 92.124 79,175
K40 Inguinal hernia (inguinal hernia) 168,574 148.272 20,302
M16 Coxarthrosis (hip joint arthrosis) 164.004 65,886 98.118
S72 Fracture of the femur (fracture of the thigh bone) 160,510 47,874 112,636

"Clinical Death"

Clinical death is a catchphrase used in political discussions and reporting in Germany to denote the decreasing number of hospitals and clinics. In other countries, attempts are being made to push outpatient care out of the hospital sector and to promote inpatient treatment as its core competence.

General

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As a result of the demographic development in connection with the differentiation of services according to inpatient treatment, outpatient treatment and rehabilitation as well as chronic or geriatric long-term treatment, the number of hospitals will continue to decrease, according to analyzes of various consulting firms. In 2012, an oversupply of around 10% of beds for inpatient treatment was estimated. The situation will worsen if there is a further differentiation of treatment according to the achievable outcome and insured effort.

According to calculations by the management consultancy McKinsey , every third of the clinics examined will no longer be able to cover their costs after the convergence phase. The German Hospital Society estimated that by 2014 around 330 of the previous 2,200 hospitals in Germany will be redundant.

Proponents of the changes see the increasing reduction in hospital beds in Germany from an economic and health policy point of view as an urgently needed reduction in overcapacities, which will not affect the quality of nationwide care. Rather, it makes an important contribution to securing the financing of the health system.

There is an expectation that in structurally weak areas the comprehensive supply of all services can no longer be guaranteed in the local area (cf. Lüngen, Lauterbach 2002). This contrasts with the mandate and the political will of many state governments to secure supplies in structurally weak regions.

Statistics of hospitals by federal state (2009)

Clinics with a low staffing level, reduced operating costs or increased efficiency and abstinence from training the next generation get by better economically than hospitals with a traditional supply mandate. Classic productivity terms are not easily applicable due to the unsteady volume of patients and the statutory health care mandate.

So far, only a few hospitals have filed for bankruptcy, for example in 2005 the Evangelical Hospital Rheda-Wiedenbrück (70 beds). The number of hospital closures since 2000 is low. Between 2003 and 2014 74 hospitals were closed in Germany. As a rule, hospitals in an economically critical situation are sold to private hospital chains by the municipalities, counties and the federal states (e.g. university hospitals) . University hospitals are increasingly being converted into other legal forms, e.g. B. convicted as an institution under public law .

Changes in the operator or changes in the legal form should allow employees to be remunerated in accordance with in- house collective agreements . This runs counter to the expected shortage of qualified personnel and the consequent long-term increase in salaries compared to the consumer price index .

Change of the remuneration scheme through the DRG accounting system

As a result of long-term reform efforts in the German hospital sector, most recently the introduction of the DRG accounting system, structural changes have occurred in the hospital landscape that will continue after the convergence phase in 2009 has ended. The DRG system replaces the previously individually negotiated care rates with a clinic-specific, but nationwide uniform, diagnosis-dependent flat-rate remuneration for each treatment case until 2009. Even after 10 years, the DRG accounting system cannot provide complete data for medical reasons. The exceptions are determined by the self-government in particular for special institutions through the annual agreement for the determination of special institutions - VBE .

Since the introduction of the DRG, the length of stay in hospital has initially decreased: from 8.9 days in 2003 to 8.7 days in 2004 and 7.3 days in 2015. There is no evidence that this development will continue or will last. In order to reassure the critics of the introduction of the DRG, the legislator has stipulated in Section 17 b (8) of the Hospital Financing Act that an accompanying research report must be submitted. There is no proof that the DRG billing system will prove to be a long-term concept for reducing overall costs. Rather, economically successful clinics show a strategy of specifically increased treatment cases with the same number of patients. A critical political discussion has not yet taken place in a coherent manner.

Situation in 2010

In May 2010 the " Hospital Rating Report 2010" of the Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI) was published. Together with the consultancy Admed , the RWI analyzed more than 700 annual hospital accounts. According to this, around 20% of the hospitals with fewer than 200 beds are at risk of insolvency, while the figure is 13% for the large hospitals.

  • The financial injection granted by the federal government in 2009 to support hospitals (over three billion euros) has helped: today (as of 2010), most German hospitals are doing relatively well economically.
  • However, if they do not increase their efficiency in the next few years, the number of clinics threatened by bankruptcy threatens to rise from 11% to 18% in 2020.
  • Small hospitals may v. a. therefore get significant difficulties if their service portfolio is too broad. When analyzing the numbers, clinics with only one or two specialist departments perform significantly better than those with three or more departments.

One recipe for success could therefore be to focus on a few services.

  • Clinics in West Germany are threatened with high pension expenses through payments in pension funds. East German houses usually do not belong to any additional public pension.
  • For rural areas in particular, the study predicts that the current infrastructure will no longer meet demand in the medium to long term and cannot be maintained at its current level. Declining tax revenues of the municipalities (economic crisis) exacerbate the situation. The annual deficit of the municipal clinics will almost double in the next three years to 439 million euros.
  • The more than 2,000 hospitals must continue to improve their efficiency so that costs do not rise faster than revenues. Since public investments tend to decline regardless of the obligations under the Hospital Financing Act, companies should strengthen their internal financing power, i.e. generate investment funds from their own resources.
  • Satisfied patients could help. According to the study, clinics in which the patients show a high level of satisfaction tend to have a better rating than others.

Todays situation

In 2019, the non-profit Bertelsmann Foundation published a simulation and analysis of a restructuring of hospital care using the example of a supply region in North Rhine-Westphalia. The experts involved called for a significant reduction in the number of German clinics in order to improve overall care. The difficult financial situation makes this necessary. Only in sufficiently large clinics could specialist positions be filled around the clock. The shortage of nursing staff could also be reduced there. Furthermore, the availability of computer tomographs and other important devices is improving. The proposals were sharply criticized, among other things, by the clinics because they feared a restriction of basic care.

Privatization of hospitals

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

First mixed-financed and privately run new acute hospital building in Germany - Helios Klinikum Meiningen (1995)

While the share of public institutions decreased from 46% to 28.8% from 1991 to 2017, the share of privately owned institutions increased from 14.8% to 37.1%. The hospital market is increasingly determined by large, profit-oriented companies such as Asklepios, Rhön, Sana or Helios. However, due to the higher average number of beds per clinic, a total of 48.0% of hospital beds are borne by public institutions (18.7% by private institutions), although the trend there is also going in the same direction.

Private clinic operator in Germany with sales figures in million euros
Clinic operator Sales 2006 2010 sales Sales 2011 sales

2015

Rhön Clinic 1.933 2,550 2,629 1.108
Helios Clinics / Fresenius 1,673 2,520 2,665 5,578
Asclepius 2,150 2,305 2,557 3,099
Sana clinics 792 1,485 1,629 2,329
Nice clinics 348 558 575 743
Damp Holding 422 487 475
Mediclin 378 487 493 555
Ameos 244 377 > 400 685
SRH clinics 342 360 565 841
Paracelsus clinics 284 336 331 373
For comparison, the largest municipal hospital group:
Vivantes 718 837 865 1,085
For comparison, the largest denominational hospital group:
St. Francis Foundation Münster 400 602 624

Structure of a hospital

Organizational structure

A hospital is structured according to the specialist departments (e.g. surgery, internal medicine, etc.). A distinction is made between bed management and diagnostic departments (e.g. radiology). There are also a number of medical institutes (e.g. pathology) at larger hospitals. All smaller units (outpatient departments, day clinics) are assigned to a specialist department. Each specialist department is headed by a chief physician .

The management consists of the head of administration (commercial manager, administrative director), the medical director (medical director) and the nursing management .

However, more and more hospitals are opting to break away from the historical vertical hierarchical structures and are placing process organization in the foreground.

In addition to the outpatient clinic for brief treatment of patients who otherwise live at home, there is inpatient hospital admission. Admission refers to both an administrative department in the hospital to handle the admission formalities and these formalities themselves (patient admission). Hospital admission is linked to the conclusion of a contract which, in addition to medical treatment, includes optional services, e.g. B. may include the type of accommodation, head physician treatment and their payment. Until discharge, the various services must be recorded and billed promptly and promptly according to the course of treatment. A hospital information system is used for this purpose , which is set up as a database and, above all, makes the “ workflow ” traceable (also called coordinating clinic management ). The information collected can be made available to the departments involved (possibly via controlling ) by the data center quickly and in a sufficiently anonymous form.

Newer (modular) structure

Sickroom

More recently, the organizational structure of hospitals has been converted to a so-called modular system or a modular organization with the aim of greater efficiency. Only therapeutic, diagnostic and nursing areas are distinguished.

According to this system, there are the following areas in nursing :

  • Low Care Station
    For the admission of only slightly in need of care or short-term inpatient treatment, mostly relatively mobile patients.
  • Normal station
    Used for the care and treatment of bedridden patients who do not require intensive care.
  • Monitoring station ( intermediate care )
    A ward in which non-ventilated patients can be monitored on the monitor in intensive care, but no (comprehensive) intensive care care is possible.
  • Intensive Care Unit
    Care of long-term care-intensive patients and patients requiring ventilation.

There is also the formation of centers in which one orientates oneself on clinical pictures. This is intended to optimize the so-called treatment pathways in patient care.

Functional structure

A hospital can be divided into functional areas:

In Germany, DIN 13080 regulates the subdivision of a hospital, a fact that plays an important role in the state funding of hospitals.

Costs of hospitals in Germany

overview

In all federal states of Germany there are a total of 1925 facilities that meet the definition of a hospital (as of the end of 2018). According to the Federal Statistical Office, the number has decreased by 486 since 1991, while the number of people treated increased from 14.6 million to 19.4 million. According to the health administration, the reduction is intended to achieve better quality and better utilization of hospitals, to reduce costs and to bundle staffing levels. - Prior to the start of the coronavirus pandemic in spring 2020, the profitability of a hospital with the help of a structural fund that finances the closings. However, politicians are now considering a rethink. The focus should be on comprehensive patient care close to home. The core mission of hospitals with protecting and saving lives should become part of public services that should not be controlled in a market economy. - But there are still supporters for the dismantling of hospitals, including health expert Karl Lauterbach . He and others refer primarily to a study carried out by the Bertelsmann Foundation under the responsibility of Reinhard Busse .

The hospital financing may monistic , usually via one or as public houses in Germany Dual financing done by the public sector (investment grants of countries) and health insurance. In addition to this income, there are additional services.

The costs of the hospitals in 2011 totaled 81.8 billion euros. In addition, the costs of the training centers in the amount of 600 million euros and the expenditure for the training fund in the amount of 1.1 billion euros, which is used in several federal states to finance the costs of training. This also includes costs for non-inpatient services in the amount of 10.8 billion euros, of which 3.7 billion euros for outpatient costs and 2.7 billion euros for scientific research and teaching. The costs for inpatient hospital care only were therefore 72.6 billion euros in 2011.

In 2011, the inpatient treatment of a patient in Germany cost an average of 3,960 euros per case. A total of 18.3 million patients were treated as inpatients in 2011.

Data according to § 21 KHEntgG

According to the German Hospital Charges Act KHEntgG , every German hospital must transmit certain hospital and case-related data to the DRG data center by March 31 of each year at the latest. These data include a. the age of the patient, admission and discharge times, diagnoses, procedures, etc. B. Information on outpatients treated. The introduction of the obligation to transmit data means that German hospitals transmit comparable data. This enables performance comparisons, which are carried out both by the federal government and by individual hospitals in the association.

Excerpt from § 21 KHEntgG: "The hospital transmits the data according to paragraph 2 on a machine-readable data carrier on March 31 for the respective previous calendar year to a body at federal level to be designated by the contracting parties according to § 17b paragraph 2 sentence 1 of the Hospital Financing Act ( DRG data point) "

In addition, some so-called "calculation houses" transmit their cost data on these cases. The transmitted data is used by the Institute for the Hospital Remuneration System (InEK) to calculate the DRG flat rate per case, see also German Diagnosis Related Groups (G-DRG).

Since the data is collected from every hospital, there are also numerous (paid) programs that process the collected data for the hospitals and make them available for various purposes, be it for reporting purposes or for the creation of quality reports. This means that the data has now become a data source that hospitals can hardly be imagined without, as they enable the use of various programs from various manufacturers on a broad basis due to the statutory norms.

Overview by federal state

Costs of hospitals in Germany in 2011 (Federal Statistical Office)
Year / state Population Dec. 31, 2011 health
houses 		beds Number of cases Gross total costs
in EUR 		of which
personnel costs
in EUR 		Share of
personnel costs
 including
material costs
in EUR 		Share of
material costs
 Adjusted costs
per case in EUR *
Baden-Württemberg 10,786,227 285 56,910 2,059,083 10,462,693,000 6,450,228,000 61.65% 3,696,022,000 35.33% 4,218
Bavaria 12,595,891 370 75,827 2,811,503 12,756,283,000 7,643,317,000 59.92% 4,780,687,000 40.08% 4,041
Berlin 3,501,872 79 19,905 771.418 3,873,529,000 2,137,817,000 55.19% 1,638,180,000 44.81% 4,276
Brandenburg 2,495,635 53 15.210 544,582 2,046,111,000 1,169,716,000 57.17% 838,347,000 42.83% 3,569
Bremen 661,301 14th 5.134 200.279 935,471,000 528,823,000 56.53% 375,888,000 43.47% 4,424
Hamburg 1,798,836 47 12,071 461.221 2,594,567,000 1,383,746,000 53.33% 1,210,821,000 46.67% 4,628
Hesse 6.092.126 174 35,941 1,299,328 5,867,105,000 3,345,084,000 57.01% 2,342,194,000 42.99% 4,060
Mecklenburg-Western Pomerania 1,634,734 39 10,375 410.150 1,661,860,000 962,588,000 57.92% 674,509,000 42.08% 3,575
Lower Saxony 7,913,502 197 42.204 1,615,879 7,391,018,000 4,413,907,000 59.72% 2,738,473,000 40.28% 3,890
North Rhine-Westphalia 17,841,956 401 121,556 4,286,435 19,513,513,000 11,665,002,000 59.78% 7,249,342,000 40.22% 3,876
Rhineland-Palatinate 3,999,117 95 25,375 890.729 3,815,467,000 2,408,637,000 63.13% 1,298,649,000 36.87% 3,807
Saarland 1,013,352 23 6,451 266,487 1,239,818,000 754,341,000 60.84% 442,742,000 39.16% 4.193
Saxony 4,137,051 80 26,467 986.173 3,904,149,000 2,220,194,000 56.87% 1,637,693,000 43.13% 3,694
Saxony-Anhalt 2,313,280 49 16,388 591.354 2,365,056,000 1,438,438,000 60.82% 896,358,000 39.18% 3,645
Schleswig-Holstein 2,837,641 94 15,990 580,808 2,706,199,000 1,561,176,000 57.69% 1,058,138,000 42.31% 3,993
Thuringia 2,221,222 45 16,193 568.731 2,282,955,000 1,402,903,000 61.45% 843,955,000 38.55% 3,630
Germany 81,843,743 2,045 502.029 18,342,989 83,415,795,000 49,485,917,000 59.32% 31,647,443,000 40.68% 3,960

* = Adjusted costs = gross costs minus non-inpatient costs (e.g. outpatient clinic, scientific research and teaching). Material costs also include expenses for the training fund, costs for training facilities and interest.

Personnel costs

Cost type Sum in euros proportion of Occupational groups (selection)
Nursing service 15,708,848,000 31.7% Pflegedienstleitung (nursing director) specialist for conducting a functional unit (station management), Fachgesundheits- and nurses (Station Service), health care and nursing , health and pediatric nurses, health and care assistant / health and medical care helper , hygiene specialist etc.
medical service 14,729,248,000 29.8% Medical director , chief physicians , senior physicians , assistant physicians , etc. (excluding fee physicians )
Medical-technical service 06,675,885,000 13.4% Pharmacists , case managers , chemists , dieticians , clinical social services ( social pedagogues , social workers ), masseurs and medical lifeguards , medical assistants (medical assistants, typists in the medical and medical-technical field) , medical-technical assistants , speech therapists , orthoptists , pharmaceutical-technical assistants , Physiotherapists , psychologists
Functional service 04,870,612,000 09.8% Anesthesia technical assistant , surgical technical assistant , physiotherapist , occupational therapist , specialist nurse for intensive care and anesthesia , specialist nurse in the surgical service , midwives and maternity nurses, ambulance services, surgical assistants , complaints and risk managers , nurses in outpatient care
Administrative service 03,160,629,000 06.4% Commercial manager, specialist in social and health services , business economist, specialist social affairs, commercial assistant , businessman in health care , office clerk , medical controller , accountant , secretaries, etc.
Economic and utility service 01,607,176,000 03.2% Buyers , specialists for warehouse logistics , warehouse clerks, kitchen staff and nutritionists , porters, supply assistants, employees for disposal, pick-up and delivery services, etc.
Other personnel costs (e.g. clinical house staff, technical service, special services) 02,733,520,000 05.5% Craftsmen (eg. Electrician , plant mechanic for sanitary, heating and air conditioning , Gardener / Horticulture Trade artisans , painters and finishers ), caretaker , home economics manager , home and cleaning staff ( cleaners , cleaners , textile cleaners ), medical technicians , Technical Director, Technical manager , IT system electronics technician , system administrator , pastoral worker , as well as non-attributable personnel costs, etc.

Material costs

The income and expenditure structure is determined based on the hospital accounting ordinance.

Cost type Sum in euros proportion of Examples
Medical need 15,460,952,000 48.9% Medicines , infusion solutions , medical and nursing consumables (gloves, syringes, cannulas, medical documents, wound dressings, etc.), blood , dialysis needs, implants ( e.g. implantable cardioverter defibrillator , pacemaker , vascular prostheses , stents ), medical instruments, laboratory supplies, anesthesia and Other surgical requirements, transplants, bandages, see also: List of medical products .
Maintenance eligible for maintenance 03,142,338,000 09.9% According to § 4 Demarcation Ordinance (AbgrV), only the costs of services ( maintenance ) that were provided for the area of ​​full and part inpatient hospital services and, in the case of revenue deduction, for pre- and post-inpatient services are eligible for care rates. This does not include the increase, significant change or extension of the useful life of the hospital's assets.
Economic needs 02,883,563,000 09.1% Disinfectant requirements , cleaning requirements, laundry cleaning , garden maintenance, cultural material expenses
Administrative needs 02,110,344,000 06.7% Office supplies (copy paper, envelopes), printed materials (forms, business forms), postage costs, bank charges, recruitment costs , broadcast post , telephone and provider costs, travel expenses , Literature, IT expenses (computers, printers, copiers, toner, software, data backup) etc.
Water, energy, fuels 02,057,357,000 06.5% Sewage , electricity , district heating , oil , natural gas , water
Other material costs 05,992,889,000 18.9% Food, locum doctors , temporary workers ( temporary workers ), cost of rents and leases, insurance (eg. Business liability insurance , building insurance ), (for example, along with other hospitals operated devices. Also group subsidiaries) costs for central community services or costs of external service providers (for outsourcing of areas such as laboratory, cleaning, food supply, logistics, porter service, medical technology, craftsmen, etc.), community taxes ( garbage collection , street cleaning ), disposal costs

Bed occupancy

The OECD in Paris recorded the average occupancy rate in acute hospitals. In 2005 it averaged 74.2% in 17 recorded OECD countries (2000: 73.6%). The ranking for 2005: Norway 87.5, Switzerland 86.1, Ireland 85.6, Great Britain 83.9, Japan 79.2, Austria 79, Hungary 75.7, Germany and the Czech Republic 75.6, France 73.4 , Portugal 73.2, USA 67.4, Slovak Republic 66.7, Luxembourg 64.7, Turkey 64.5, Netherlands 63.9 and Mexico 61%. (OECD Health Data 2007, OECD Paris 2007)

Number of hospitals in Germany by number of beds in 2016:

Number of beds Number of general hospitals
1 to 49 292
50 to 99 193
100 to 149 201
150 to 199 151
200 to 299 227
300 to 399 157
400 to 499 122
500 to 599 95
600 to 799 73
800 to 999 36
over 1000 60

Risks in the hospital

An evaluation of numerous studies showed that in Germany, 5–10% adverse events, 2–4% damage, 1% treatment errors and 0.1% deaths due to errors can be expected in the hospital sector. With 17 million hospital patients annually, this equates to 850,000 to 1.7 million adverse events, 340,000 harms (avoidable adverse events), 170,000 medical errors (lack of care) and 17,000 deaths attributable to avoidable adverse events. The entire outpatient area is not included. (Advisory Council on the Assessment of Developments in the Health Care System, "Cooperation and Responsibility", BMG 2007)

In 2000, an analysis by the Institute of Medicine ("To Err is Human") found that there are 44,000 to 98,000 (hospital) deaths annually in the USA from errors, which is the fatal complication rate based on the population is likely to be as high as in Germany.

In 1991, 14 million inpatients were treated, who stayed for an average of two weeks. In 2009 there were 18 million patients who stayed for about eight days. Between 1996 and 2008, 50,000 nursing jobs were cut. At the same time, 18,000 positions were created in the medical field alone and additional positions were created in the assistant field. Doctors are responsible for two thirds of all errors that occur in medication, for example through failure to observe contraindications or negative interactions. The remaining third of medication errors are the responsibility of the nursing staff, for example due to medication mix-ups. 1,000 audio recordings of doctor-patient encounters showed that only 6% of the cases provided information about the advantages and risks of a therapy method; The patient's wishes were discussed only in every fifth interview.

Every year, around 500,000 hospital patients develop infections. Around 150,000 of these are attributed to poor hygiene by doctors and nursing staff. Contributions like the Stern article "Crisis Area Hospital" in 2010 ultimately contributed to the fact that the topic of hygiene has moved more into the focus of the public.

From a health policy point of view, hygiene is a matter for the federal states and is regulated by corresponding statutory ordinances of the individual federal states. The Federal Ministry of Health therefore has no influence. Statutory health insurance companies are not allowed to make recommendations, i.e. not offer a selection of hygienic clinics. Here, especially with MRSA , large differences can be observed in the spread of multi-resistant germs between individual hospitals and in different federal states. Alternatives are review portals for clinics. Indirect ratings can be obtained from the number of medical errors, also known as malpractice .

Situation in Austria

In Austria, hospitals are mostly referred to as hospitals , but rarely in the name of the houses (e.g. Orthopedic Spital Speising). The basic supply with general public hospitals is mainly guaranteed by state-owned houses. There are also community and religious hospitals.

Situation in Switzerland

In German-speaking Switzerland, hospitals are usually called hospitals . There are different categories of hospitals across the country: University hospitals in cities with universities that run medical faculties, canton hospitals in all cantons , regional and community hospitals, and private hospitals and clinics . A political discussion is currently underway as to whether the cardiac surgery department should be combined in a single central hospital in German- and in French-speaking Switzerland for cost reasons . Also for cost reasons, there is a dispute about how many smaller hospitals can be closed without endangering the supply mandate ( e.g. emergency services ).

In the canton of Zurich , the municipalities are no longer responsible for hospital care. At the See-Spital, the contributions invested by the sponsoring communities over the past ten years are converted into an interest-bearing loan. Most of Zurich's municipalities are no longer deficit guarantors, but creditors and shareholders. Many of the previous hospital special-purpose associations as public institutions are being converted into private-law sponsorships in the form of stock corporations or foundations.

See also

Belegarzt - German Hospital - Length of Stay - Hospital Pharmacy - Hospital Revision - forensic - patient admissions - Nursing Services - nursing - care scandal - standard of care - Studienhospital - day hospital - Visite

Types of hospital: anthroposophic hospital - professional association accident clinic - specialist hospital - private clinic - psychiatric clinic - psychosomatic clinic - sanatorium - accident hospital

literature

  • Michael Arnold, Jürgen Klauber, Henner Schellschmidt: Hospital Report 2002 . Schattauer, Stuttgart 2002, ISBN 3-7945-2219-2 . (Periodical).
  • Ernst Bruckenberger: Long-term hospital patient: Diagnoses and healing approaches . Lambertus, Freiburg im Breisgau 1989, ISBN 3-7841-0440-1 .
  • Peter Eichhorn, Hans-Jürgen Seelos, Johann-Matthias G Schulenburg (eds.): Hospital management . Urban and Fischer, Munich / Jena 2000, ISBN 3-437-21590-6 .
  • M. Eversmeyer: The DRG system does not stop the increase in expenditure in Australia. In: f & w, management and economics in hospitals. 3 (2001), pp. 230-232.
  • Michel Foucault : The Birth of the Clinic . 1963. (Paperback edition: Fischer, Frankfurt am Main 1988, ISBN 3-596-27400-1 ).
  • Dieter Jetter: Basics of the history of the hospital. 1800-1900 . Scientific Book Society, Darmstadt 1977, ISBN 3-534-07278-2 .
  • Ludwig Klasen: Ground plan models of all kinds of buildings. Abth.IV. Healthcare and sanatorium buildings . Baumgartner, Leipzig 1884.
  • Jürgen Klauber, Bernt-Peter Robra, Henner Schellschmidt (eds.): Hospital Report 2006 - Focus: Hospital market in transition . Schattauer, Stuttgart 2006, ISBN 3-7945-2490-X .
  • M. Lüngen, K. Lauterbach: Do DRG lead to the specialization of hospitals? In: Health Economics and Quality Management. 7 (2002), pp. 93-95.
  • Bernhard Mann: Hospital Sociology and Health Care . In: Sociological Review. Volume 27 (2004), ISSN  0343-4109 , pp. 480–491.
  • Axel Hinrich Murken: From the poor hospital to the large hospital. The history of the hospital from the 18th century to the present . DuMont, Cologne 1988, ISBN 3-7701-2134-1 .
  • Barbara Schmidt-Rettig, Siegfried Eichhorn: Hospital management teaching. Theory and practice of an integrated concept. Kohlhammer, Stuttgart 2008, ISBN 978-3-17-019914-9 .
  • Norbert Andersch: Hospital development and trade union hospital policy: an overview with special consideration of the ÖTV. Verl. Arbeit & Gesellschaft, Marburg 1990, ISBN 3-89419-010-8 . (Zugl .: Frankfurt (Main), Univ., Diss.)
  • A. Vera, K. Foit: Modular hospital organization and efficiency In: ZfB - Zeitschrift für Betriebswirtschaft , 4, 2005, pp. 357–382.
  • A. Vera, M. Lüngen: The reform of hospital financing in Germany and the effects on hospital management In: WiSt - Wirtschaftswwissenschaftliches Studium , 11, 2002, pp. 638–643.
  • A. Vera: New organizational structures in German hospitals after the introduction of the DRG In: Health Economics & Quality Management , 1, 2004, pp. 25–31.
  • A. Vera: The "industrialization" of the hospital system through DRG case flat rates - an interdisciplinary analysis . In: Das Gesundheitwesen , 3, 2009, pp. 161–162 and pp. E10-e17.
  • Arne Thomsen: Catholic hospital system in the Ruhr area. Developments and actors from the beginnings of industrialization up to the First World War (sources and studies. Publications by the Institute for Research on Church History of the Diocese of Essen, Volume 14). Aschendorff Verlag, Münster 2012, ISBN 978-3-402-14621-7 .

Web links

Wiktionary: Hospital  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Clinic  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Spital  - explanations of meanings, word origins, synonyms, translations
Wikiquote: Hospital  Quotes
Commons : Hospital  album with pictures, videos and audio files

Hospital directories

Hospital health policy

Individual evidence

  1. ↑ clinic : from the Greek klinikos , bedridden 'of Kline , stock'; as a term used in German since 1843 for an institution for teaching medicine (cf. preclinical and clinic in medical studies ) via French clinique from Greek klinīkḗ I. supply level or . klinīkḗ téchnē , 'medicine', from which also Clinik emerged and has been documented as 'practicing medicine' since 1813 (see also clinic in the sense of clinical picture ). Source: Friedrich Kluge , Alfred Götze : Etymological dictionary of the German language . 20th edition. ed. by Walther Mitzka . De Gruyter, Berlin / New York 1967; Reprint (“21st unchanged edition”) ibid 1975, ISBN 3-11-005709-3 , p. 377 f.
  2. ↑ Reza Madjderey : Borsuye. In: Borsuye. Journal for Medicine a. Culture 10, 1998, 39, p. 47
  3. ↑ Kaveh Farrokh: Shadows in the Desert: Ancient Persia at War. Osprey Publishing, Oxford 2007, p. 241.
  4. ↑ Manfred Mai: World History . Carl Hanser Verlag, 2002, p. 47.
  5. ↑ Tamin Ansary: The unknown center of the world , Campus Verlag, 2010, p. 115.
  6. ↑ A. Vera: The "industrialization" of the hospital system through DRG case flat rates - an interdisciplinary analysis . In: Das Gesundheitwesen , 3, 2009, p. 161 f., P. E10 ff.
  7. ^ Matthias Klein: Foray through hospital law - conference report on the hospital law day 2013 in Düsseldorf, NZS 2013, p. 777
  8. ↑ Basic data of the hospitals. Federal Statistical Office, 2015
  9. ↑ Basic data of the hospitals 2015. (PDF) Federal Statistical Office, accessed on October 19, 2016 .
  10. ↑ Basic data of the hospitals 2015 - Fachserie 12 series 6.1.1. (PDF) Federal Statistical Office, accessed on October 19, 2016 .
  11. ↑ Development of hospital care 1991–2010 (PDF; 175 kB), Sozialpolitik-aktuell - University of Duisburg-Essen; see commentary and methodological notes
  12. ↑ destatis.de of the Federal Statistical Office
  13. ↑ G. Fochler-Hauke ​​(Ed.): Der Fischer Weltalmanach 1973 - Numbers, data, facts . Fischer, Frankfurt / M. 1972, p. 62.
  14. ↑ DKG on the latest OECD figures: German hospitals top in an international comparison . findarticles.com, Occupational Therapy & Rehabilitation, September 2007
  15. ↑ Overall diagnoses. (No longer available online.) Federal Statistical Office Germany, archived from the original on October 20, 2011 ; accessed on September 30, 2015 .
  16. ↑ https://www.marburger-bund.de/landesverbaende/nrw-rlp/artikel/allgemein/2017/ist-das-kliniksterben-noch-zu-stoppen  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Toter Link / www.marburger-bund.de  
  17. ↑ Dirk Andres: Die Kliniksterben in Deutschland ?: How hospitals can find a way out of the imbalance. In: Focus Online . June 20, 2015, accessed October 14, 2018 .
  18. ↑ aerzteblatt.de
  19. ↑ presseportal.de
  20. ↑ a b aerztezeitung.de
  21. ↑ cf. For example, full ambulances: Overcrowded hospitals, empty ordinations . Andreas Wetz in: Die Presse online, January 6, 2014.
  22. ↑ A. Vera, M. Lüngen: The reform of hospital financing in Germany and the effects on hospital management . In: WiSt - Das Wirtschaftsstudium , 11, 2002, p. 638 ff.
  23. ↑ Accompanying research in accordance with Section 7b (8) of the KHG. Retrieved October 19, 2016 .
  24. ↑ http://www.admed.com/website_deu/pdf/ADMED-RWI-Krankenhaus-Rating-Report-2010-ExecSum-SK.pdf (link not available)
  25. ^ Stefan Loos, Martin Albrecht, Karsten Zich: Sustainable hospital care . Bertelsmann Stiftung, Gütersloh 2019, doi : 10.11586 / 2019042 ( bertelsmann-stiftung.de [PDF; accessed on September 12, 2019]).
  26. ↑ Radical demand in Bertelsmann study: Should more than every second clinic in Germany close? In: Manager Magazin. July 15, 2019, accessed September 6, 2019 .
  27. ↑ Study on hospital care: Experts call for every second clinic to be closed. In: Spiegel Online. July 15, 2019, accessed September 6, 2019 .
  28. ↑ Rolf Zamponi: Clinics sharply criticize the study . In: Hamburger Abendblatt . Edition Hamburg-Harburg. July 19, 2019, p. 23 .
  29. ↑ Basic data of the hospitals. (PDF) Federal Statistical Office , 2017, p. 8
  30. ↑ a b Federal Statistical Office (2015), Hospital Statistics, Fachserie 12, Reihe 6.1.1.
  31. ↑ Süddeutsche Zeitung , October 19, 2007.
  32. ↑ Rhön-Klinikum AG (Ed.): Annual Report 2015 . tape 2015 , p. 210 .
  33. ↑ Sales and earnings. Helios Kliniken GmbH, accessed on August 19, 2017 .
  34. ↑ Asklepios Klinik GmbH (Ed.): Annual Report 2015 . Hamburg, S. 81 .
  35. ↑ Sana Kliniken AG (Ed.): Annual Report 2015 Sana Kliniken AG - 40 years in motion . Ismaning, S. 138 .
  36. ↑ Schön Klinik SE (Ed.): Annual Report Schön Klinik SE 2015 . S. 45 .
  37. ↑ Group sales increased by 3.2% to EUR 555.3 million and group EBIT increased by 51.7% to EUR 23.6 million. Mediclin AG, accessed on August 19, 2017 .
  38. ↑ AMEOS 2015 - the portrait. (PDF) Ameos Group, accessed on August 19, 2017 .
  39. ↑ SRH Holding (Ed.): Annual Report 2015 SRH Kliniken .
  40. ↑ Paracelsius Clinics Germany (ed.): Values ​​Live Security - Annual Report 2015 . S. 115 .
  41. ↑ Vivantes - Netzwerk für Gesundheit GmbH (Ed.): Vivantes - Annual Report 2015 . Berlin, S. 71 .
  42. ↑ A. Vera, K. Foit: Modular hospital organization and efficiency . In: ZfB - Zeitschrift für Betriebswirtschaft , 4, 2005, p. 357 ff.
  43. ^ A. Vera: New organizational structures in German hospitals after the introduction of the DRG . In: Health Economics & Quality Management , 1, 2004, p. 25 ff.
  44. ^ Kai Schlieter: The state sponsored end of hospitals . In: Berliner Zeitung , June 25, 2020, p. 2.
  45. ↑ destatis.de
  46. ↑ gbe-bund.de
  47. ↑ a b Patient operating field . In: Süddeutsche Zeitung , June 4, 2008, p. 2
  48. ↑ a b c d e hospital crisis area . In: Stern , 36/2010, p. 34 ff.
  49. ↑ de.statista.com
  50. ^ Hospital Compass ( Memento from February 14, 2014 in the Internet Archive )
  51. ^ E. Gruner, B. Junker: Citizens, State and Politics in Switzerland .
  52. ↑ nzz.ch (accessed on: June 5, 2012).