# Hospital planning

The hospital planning or hospital requirements planning develops the existing regional bed- continued and power capacity to ensure patient health care.

## Hill-Burton Formula (HBF)

Using the Hill-Burton formula developed in the USA in the 1960s , based on the “Hospital Survey and Construction Act (also Hill – Burton Act)” passed in 1947, supported by US Senators Harold Hitz Burton and J. Lister Hill , the need for beds is still being determined in Germany. The formula takes into account the determinants of the number of inhabitants , length of stay , hospital frequency and degree of bed utilization ( degree of occupancy).

The number of inhabitants is based on the statistical data of the federal state. These are forecast to determine the population development up to the target year of the hospital plan. The length of stay is the average number of days a patient spends in the hospital. Admission and discharge days count together as one day. The hospital frequency is the relation of the patients living in a certain area who are treated as inpatients during the year to the population of the area concerned. The bed utilization rate is the ratio of the care days to the number of planned beds per year.

${\ displaystyle \ mathrm {Bed requirements = HBF} = {\ frac {{\ text {Population}} \ cdot {\ text {Hospital frequency}} \ cdot {\ text {Length of stay}} \ cdot 100} {1000 \ cdot {\ text {bed occupancy}} \ cdot 365 \, {\ text {days}}}}}$

Example: For a region with 1 million inhabitants, a hospital frequency of 20 percent (corresponds to 200 hospital admissions per 1,000 inhabitants), and an average length of stay of 11.0 days, with a bed utilization rate of 82 percent, this would result in a requirement of 7,350 beds.

## National

### International comparison of hospital beds

The table Development of the number of hospital beds per 100,000 inhabitants shows the number of patient beds that was officially determined for inpatient treatment in a care facility or a facility that also offers inpatient care and can be admitted for at least one night. Inpatient care is provided by hospitals, nursing homes and nursing homes as well as by other facilities that are counted as outpatient care facilities due to their main care activity, but also offer inpatient care as a secondary activity.

In a European comparison, Germany has a very large number of hospital beds. Nevertheless, around 140 hospitals were closed between 1991 and 1998 and overcapacities of around 140,000 hospital beds were reduced.

Green background ... means an increase in the population-related number of beds (beds per 100,000 inhabitants)
year Germany Austria Switzerland France Italy
1993 968.6 755.9 750.6 926.6 667.9
1994 972.3 761.4 702.1 905.6 653.5
1995 969.8 755.1 700.8 890.0 622.1
1996 957.8 746.3 665.9 872.1 649.5
1997 938.0 736.6 663.7 853.1 582.3
1998 929.3 723.9 664.0 871.4 548.7
1999 919.4 808.2 660.8 820.1 492.7
2000 911.6 794.8 628.7 797.0 470.8
2001 901.0 784.8 603.6 782.7 461.3
2002 887.3 780.7 594.5 771.3 443.4
2003 874.4 773.3 582.4 754.6 415.9
2004 857.8 773.4 567.0 739.0 398.6
2005 846.7 768.7 553.9 722.5 399.9
2006 829.7 776.5 539.1 777.6 393.9
2007 823.9 766.2 536.0 706.0 384.5
2008 821.4 767.9 521.1 690.3 372.7
2009 823.9 765.9 510.4 666.1 362.6
2010 824.8 762.9 496.3 642.8 357.1
2011 822.2 764.7 487.0 637.2 342.5
2012 818.3 767.4 480.2 634.1 342.2
2013 820.2 764.5 467.7 628.5 331.2
2014 822.8 758.8 458.4 619.7 321.1
2015 813.3 753.7 458.4 613.5 319.6
2016 806.3 742.1 454.5 605.9 317.2
2017 800.2 736.6 452.7 598.0 318.1
2018 k. A. 727.2 462.8 590.9 314.1
Source: Eurostat

### Germany

In Germany , the responsibility for an adequate supply of hospital beds and hospital services lies with the federal states .

The legal basis of these so-called state hospital plans is the nationwide hospital financing law (§ 6 KHG) and state hospital laws , such as the Lower Saxony Hospital Act (NKHG).

The federal states therefore have the right to decide on the approval of a hospital for the care of inpatients. In Germany, Section 108 of Book V of the Social Security Code (SGB V) obliges the health insurance companies to reimburse treatment costs in those hospitals that are listed in the plan, the so-called plan hospitals . The university hospitals are automatically included.

While the health insurers are otherwise free to choose their contract houses, in these cases they are forced to negotiate care rates. In this way, the costs for uneconomical beds that are kept in stock must be co-financed by the solidarity community of the insured. If a health insurance company wants to exclude a hospital from the planning, it can apply to the state to do so.

New investments and maintenance investments by hospitals are partly contested by the federal states ( dual financing ). When distributing the funds and updating the plans, the federal states are legally obliged ( Section 7 KHG ) to seek an agreement with the state hospital companies and the health insurance companies. The medical and nursing associations and the statutory health insurance associations are not asked for these plans.

When a hospital operator changes, for example when a hospital is privatized, the state governments are not automatically involved.

### Austria

In Austria, the federal states draw up state hospital plans in accordance with Section 10a KAKuG . In the case of general hospitals , according to § 2a KAKuG, a distinction is made between standard hospitals , which must have at least departments for surgery and internal medicine, and specialized hospitals , which have to cover nine other specialist areas. Furthermore, there are central hospitals , which basically maintain all specialized facilities corresponding to the current state of medical science.

### Switzerland

In Switzerland, hospital planning is the responsibility of the cantons . According to Art. 39 KVG, hospitals (hospitals) are permitted if they meet certain organizational requirements, which correspond to the plan drawn up jointly by one or more cantons for needs-based hospital care and are listed on the canton's hospital list, which is divided into categories according to service mandates.