Hospital treatment
Under hospital treatment refers to the different ways of medical treatment and care in a hospital . In many countries, hospital treatment is a social security benefit .
In Germany, people with statutory health insurance have a legal right to hospital treatment. This is legally standardized in Section 39, Book V of the Social Code (SGB V). Accordingly, there is an entitlement to full inpatient hospital treatment if the treatment goal cannot be achieved through partial inpatient, pre- and post-inpatient or outpatient treatment including home nursing . With this, the law already names the possible types of hospital treatment, namely
- fully stationary,
- semi-stationary,
- pre-stationary and
- post-hospital as well
- outpatient treatment.
The necessary hospital treatment must be prescribed by the attending physician , except in acute emergencies . When the patient is admitted, the hospital checks whether the medical prerequisites for treatment in the hospital are actually met. This examination also includes the question of which type of treatment is the most suitable for the patient and the most economical for the health insurance company. Another prerequisite is that the hospital is an approved contract hospital according to Section 108 of the Book V of the Social Code.
Types of treatment
Hospital treatment can be carried out as a full inpatient, partial inpatient, pre- and post-inpatient as well as outpatient. The referring doctor or the treating doctors in the hospital decide which type of treatment is suitable for the respective patient.
- Full inpatient treatment
Full inpatient treatment is classic hospital treatment. In addition to the necessary medical treatment ( medical treatment , nursing, medicines, etc.), it also includes accommodation and meals. This variant is the most expensive and time-consuming form of treatment in the hospital and can be considered if none of the treatment types explained below are possible or medically sufficient.
Additional costs for accommodation in a single or double room or, for example, for treatment by the head physician (optional services) must be borne by the legally insured. Nevertheless, twin rooms are already standard in many hospitals, so that there are no additional costs for the patients in this regard. Such additional costs can, if desired, be covered by private supplementary insurance.
Hospital treatment should take place in suitable hospitals in the vicinity (→ section “Choice of hospital”).
- Partial inpatient treatment
Day- care treatment includes, in addition to medical care, accommodation and care either only during the day or only at night ( e.g. day clinic ). It comes into question when permanent accommodation (full inpatient hospital treatment) does not appear medically necessary. In this sense, one speaks of day or night clinical treatment.
- Pre-hospital treatment
Pre-inpatient treatment means treatment in a hospital without accommodation and meals. Pre-inpatient stays are the most suitable treatment method when it is necessary to clarify the need for full inpatient treatment or to prepare for such.
Pre-inpatient hospital treatment is limited to a maximum of three treatment days within five days before the start of the actual, fully inpatient hospital treatment.
- Post-hospital treatment
Like pre-inpatient treatment, post-inpatient treatment does not include any accommodation or meals. It comes into question if the aim is to ensure the success of treatment during an inpatient stay. Post-inpatient hospital treatment is limited to seven treatment days within a period of two weeks after the end of the inpatient stay, although there may be exceptions in medically justified cases.
- Outpatient hospital treatment
Since hospitals in Germany, with the exception of emergency outpatient departments and psychiatric institute outpatient departments, generally do not take part in outpatient medical care, outpatient hospital treatment is restricted by law to outpatient operations . The currently increasing and controversial exception to this principle is outpatient treatment in hospitals in accordance with Section 116b SGB V.
| Supply offer | Year of introduction | Anchored in SGB V | Initial law |
|---|---|---|---|
| Outpatient surgery in the hospital | 1993; 2000 | Section 115b | Health Structure Act (GSG); Statutory Health Insurance Reform Act 2000 |
| Pre- and post-inpatient treatment in the hospital | 1993 | § 115a | Health Structure Act (GSG) |
| Outpatient treatment in the hospital in the event of insufficient supply | 2004 | Section 116a | Statutory Health Insurance Modernization Act (GMG) |
| Outpatient treatment in the hospital | 2004 | Section 116b (2 ff.) (Old) | Statutory Health Insurance Modernization Act (GMG) |
| Outpatient specialist medical care (ASV) | 2012 | Section 116b (new) | Statutory Health Insurance Supply Structure Act (GKV-VStG) |
| University outpatient departments | 1955 | Section 117 (previously in Section 368n RVO ) | Law on Statutory Health Insurance Physicians (GKAR) |
| Social Pediatric Centers (SPZ) | 1989 | Section 119 | Health Reform Act (GRG) |
| Pediatric special clinics / special clinics at children's clinics | 2009 | Section 120 (1a) | Hospital Financing Reform Act (KHRG) |
| Psychiatric Institute Outpatient Clinics (PIA) | 1986 | § 118 (previously in § 368n (6) 2 RVO ) | Law to improve outpatient and inpatient care for the mentally ill (PsychKVVerbG) |
| Geriatric Institute Outpatient Clinics (GIA) | 2013 | § 118a | Law introducing a flat-rate remuneration system for psychiatric and psychosomatic facilities (Psych-Entgeltgesetz; PsychEntgG) |
| Special care (selective contracts, management contracts etc., replaces contracts according to § 73a, § 73c and § 140a-d integrated care ) | 2015 | § 140a (new) | Statutory Health Insurance Supply Strengthening Act (GKV-VSG) |
| Outpatient treatment via appointment service points | 2015 | Section 75 (1a) | Statutory Health Insurance Supply Strengthening Act (GKV-VSG) |
Most of the provisions of the law on the further development of care and remuneration for psychiatric and psychosomatic services (PsychVVG) came into force on January 1, 2017.
Choice of hospital
In principle, insured persons in Germany can freely choose the hospital in which they would like to be treated, whereby it must be an approved hospital. However, it should be noted that the doctor who prescribes hospital treatment, taking into account the disease, must indicate on the prescription the two closest hospitals that he deems suitable.
Patients who choose a hospital other than one of the suggested hospitals for no compelling reason can be charged by the health insurance company with the resulting additional costs; these can be differences in hospital costs and, above all, higher travel costs.
Compelling reasons not to use any of the hospitals specified in the ordinance may include: B. the distance of a hospital from family or relatives or religious needs. The health insurance company should also take into account other wishes of the insured.
Assumption of costs
Private health insurance contracts usually provide for hospital treatment to be covered. The entitlement in the statutory health insurance also includes the medically required inclusion of an accompanying person in the inpatient treatment of children, in the private health insurance only if contractually agreed as a service.
The accident insurance institutions also pay for hospital treatment if the illness is based on an accident at work or an occupational disease .
financing
Main article: Hospital funding
Co-payments
Insured persons over the age of 18 pay 10 euros per day of inpatient hospital treatment as an additional payment if the hospital treatment is paid for by the health insurance company. The additional payment is limited to a maximum of 28 days per calendar year. The co-payment is also required for days of leave of absence if, for example, after consulting the doctor, the patient was at home on the weekend because no surgery can be performed on the weekend.
If the cost bearer is the statutory accident insurance, no additional payment needs to be made.
Optional services
These are voluntary additional services that go beyond the necessary medical care and are offered in the area of accommodation (1 or 2-bed rooms) as well as medical (head physician treatment) and medical care. If optional medical treatment has been agreed, the radiologists, laboratory doctors and anesthetists involved can also issue private bills in addition to the chief physician or chief physicians - even if they work outside the chosen hospital. Elective services can only be billed to the patient from the day on which a written optional service agreement was concluded. Back dating is not possible. Patients have the option at any time during their hospital stay to terminate their already signed optional service agreement without notice and without notice with immediate effect. Before concluding an optional service agreement, you should check whether your private (supplementary) health insurance will reimburse the costs for certain optional services.
Individual evidence
- ↑ Consumer advice center NRW: "Your rights with optional services" ( 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.
