Hospital Financing Act

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Basic data
Title: Law on the economic security of hospitals
and on the regulation of hospital care rates
Short title: Hospital Financing Act
Abbreviation: KHG
Type: Federal law
Scope: Federal Republic of Germany
Legal matter: Special administrative law , health law , social law
References : 2126-9
Original version from: June 29, 1972
( BGBl. I p. 1009 )
Entry into force on: January 1, 1972
New announcement from: April 10, 1991
( BGBl. I p. 886 )
Last change by: Art. 16a G of April 28, 2020
( BGBl. I p. 960, 1011 )
Effective date of the
last change:
predominantly May 23, 2020
(Art. 18 G of April 28, 2020)
GESTA : M040
Please note the note on the applicable legal version.

The Hospital Financing Act (KHG) has the purpose of securing hospitals economically in order to ensure needs-based care for the population. The hospitals should be efficient and run independently. The law should also contribute to socially acceptable care rates. In particular, from 2003 onwards, hospital treatment was switched from financing via daily rates to flat-rate per case by means of classification into diagnosis- related case groups (DRG, Diagnosis Related Groups ), see also: German Diagnosis Related Groups (G-DRG).

However, the KHG does not apply to:

Since the Bundeswehr hospitals were opened to the civilian sector, they have been subject to the KHG since January 2003 insofar as they treat civilian patients.

history

Before the KHG came into force, the economic security of hospitals had been one of the problems in the Federal Republic of Germany for years, the permanent solution of which was demanded and expected not only by the hospital owners and the health insurance companies directly affected, but also increasingly by the general public. It had been known since the mid-1960s that hospital care rates no longer covered the cost of economically efficient hospitals to a large extent. An investigation by the federal government, which the German Bundestag had decided in 1966 and which was presented in 1969, had shown that the annual deficit of the hospitals, calculated according to business management principles, was around one billion DM for the period under investigation (report of the federal government on the financial situation of the hospitals - BT-Drucksache V / 4230). With an estimated fixed assets of hospitals for acute patients of DM 35 to 40 billion, persistent deficits of this magnitude meant a loss of more than 10 percent of the total fixed assets within five years from an economic point of view. This loss led in particular to the fact that hospitals were not renewed to the required extent and had to be used well beyond the generally considered appropriate maximum useful life of a hospital of 50 to 70 years. The obsolescence of the hospital stock also meant significantly higher operating expenses with the same medical performance. Insofar as outdated hospitals still operated at relatively low cost, this was at the expense of medical performance, patient accommodation and, above all, at the expense of the staff, who in such hospitals were often stressed beyond their capabilities. Every year without a fundamental reorganization meant, because of the lack of funds for the most urgent need for renewal, additional losses of billions in the usually non-profit assets invested in hospitals and a threat to the hospital care of the citizens. Such a loss was not only formed by the deficit and the associated loss of substance. In addition, there were the losses caused by the higher operating expenses of outdated hospitals and the switch to reduced occupancy.

By inserting number 19a in Article 74 of the Basic Law (22nd law amending the Basic Law of May 22, 1969, Federal Law Gazette Part I p. 363), the federal government was given the competing legislation “on the economic security of hospitals and the regulation of hospital care rates "Granted and created a co-financing competence of the federal government within the framework of Article 104 a of the Basic Law. On this basis, the KHG sees the provision of hospitals as a public task. The investment costs are from tax revenues, the usage costs are to be raised through the care rates, see also: Dual financing .

On January 1, 2019, the Nursing Staff Strengthening Act (PpSG) came into force with far-reaching changes in the DRG system for better staffing and better working conditions in nursing and geriatric care with adjustments to the Hospital Financing Act (KHG) and Hospital Remuneration Act (KHEntgG) and the inclusion of Section 137j SGB V . In it, the topics care budget, care revenue catalog, care staff quotient, care expenditure catalog, staff lower limits and care-sensitive areas are relevant factors.

Goals according to § 1 KHG

The law established three goals:

  1. economic security of the hospitals according to § 4 Abs. 1 KHG
  2. Securing needs-based supply of the population with efficient hospitals
  3. Making a contribution to socially acceptable care rates.

Hospital planning

According to § 6 Abs. 1 KHG all federal states are obliged to draw up hospital requirement plans as well as programs for the implementation of the hospital construction and its financing on the basis of the hospital requirement plans - annual hospital construction programs. The KHG does not contain any individual provisions on the content of these plans and programs. The aim of the hospital requirement plans is to ensure a needs-based supply of the population with efficient hospitals (Section 1 (1) KHG). Only hospitals that have been included in the hospital requirement plans can receive funding under the KHG (Section 8 (1) KHG).

For the promotion of the replacement of short-term capital goods (Section 10 (2) KHG), the hospitals were divided into four requirement levels:

  • Level I up to 250 beds
  • Level II 250 to 350 beds
  • Level III 350 to 650 beds
  • Requirement level IV over 650 beds.

The size classification was initially only adopted by Saarland . All other countries opted for different classifications and terminology included in the hospital needs plans.

Quality requirements

Hospitals that show a significant degree of inadequate quality in the relevant planning-relevant quality indicators according to Section 6 (1a) (standards and evaluation criteria of the GBA or the quality specifications provided for in the respective state law) may not be included in the hospital plan (Section 8 (1a) The Law).

See also

Web links