Care level

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Care level is a term from hospital planning in Germany. With the Hospital Cost Reduction Act (KHKG) of December 22nd, 1981 (Federal Law Gazette I, p. 1568), the instruments for demand planning should be improved and a change in investment funding. The hospitals were henceforth divided into four levels of care by the federal states in the hospital plans.

In their hospital laws, some federal states divide the general hospitals approved for hospital treatment according to § 108 SGB V into three or four categories. Specialist hospitals are not assigned to any care level. Most countries, on the other hand, do not differentiate between levels of care in their hospital plans, but differentiate their supply of hospital beds in other ways.

Comparison of the structures of hospital care by country before the introduction

Names in the federal states according to hospital requirements planning around 1974:

  • Baden-Württemberg :
    • Basic and supplementary care hospital (100 to 250 beds)
    • Standard care hospital (approx. 460 beds)
    • Central supply hospital (900 to over 1200 beds)
    • Maximum care hospital (approx. 1800 beds)
  • Bavaria :
    • 1st level hospital (approx. 300 beds)
    • Second level hospital (approx. 500 beds)
    • III Hospital Care level (significantly more than 500 beds)
  • Hessen :
    • Minimum care hospital (150 to 199 beds)
    • Primary Care Hospital (200 to 299 beds)
    • Standard care hospital (300 to 499 beds)
    • Central Supply Hospital (500 to 699 beds)
    • Maximum care hospital (700 to over 1000 beds)
  • Lower Saxony :
    • Primary care hospital (at least 100 beds, usually 200 to 250 beds)
    • Standard care hospital (at least 200 beds, usually 400 to 600 beds)
    • Central care hospital (at least 400 beds, usually over 600 beds)
  • North Rhine-Westphalia :
    • Basic care level hospital (no information on the number of beds)
    • Hospital of high general care (no information on the number of beds)
    • Top care hospital (no information on the number of beds)
  • Rhineland-Palatinate :
    • Primary care hospital (up to 250 beds)
    • Standard care hospital (250 to 500 beds)
    • Specialized hospitals (over 500 beds)
  • Saarland :
    • Primary care hospital (up to 250 beds)
    • Standard care hospital (251 to 350 beds)
    • Central Supply Hospital (351 to 650 beds)
    • Maximum care hospital (over 651 beds)
  • Schleswig-Holstein :
    • Regular hospital (at least 300 beds)
    • Specialized hospital (at least 370 beds)
    • Central hospital (at least 1360 beds)

Regulations with levels of care

Whereas in the past a differentiation was usually made according to four levels of care (basic, standard, priority and maximum care), today, by merging the first two levels, only three levels of care are often defined.

Bavaria

In Bavaria , the hospital plan of the Free State of Bavaria regulates the levels of care as follows:

I. Level of care

These hospitals serve basic care. Hospitals of the first level of care should be made available depending on the existing need for acute inpatient basic care in regional and medium-sized centers.

II. Level of care

These hospitals also fulfill regional priority tasks in diagnosis and therapy. Hospitals of the second level of care should be made available in regional centers in accordance with the individual need for differentiated focus care.

III. Care level

These hospitals provide a comprehensive and differentiated range of services as required, as well as corresponding medical-technical facilities. University clinics take on III. Care level true. They are to be included in the hospital planning, taking into account their research and teaching tasks. III. The level of care should be made available in regional centers as required.

Rhineland-Palatinate

The state of Rhineland-Palatinate has defined the division into care levels in Section 6 of the State Hospital Act (LKG), without defining them in more detail. The individual levels of care are defined in the state hospital plan, which currently provides for the following levels of care:

  • Primary care hospitals
  • Standard care hospitals
  • Specialty hospitals
  • Maximum care hospitals

Saxony

In Saxony , the three levels of care in Section 4 (2) SächsKHG are defined as follows:

I. Level of care

Standard care hospitals must specialize in surgery and / or internal medicine. If a corresponding need is determined, they can also provide the fields of gynecology and obstetrics, ophthalmology, ear, nose and throat medicine, orthopedics, paediatrics, psychiatry and urology, for example. They should not have their own departments for sub-areas of a specialty within the meaning of the advanced training regulations of the Saxon State Medical Association .

II. Level of care

Specialist care hospitals also perform supra-local priority tasks in diagnosis and therapy. They include the fields of surgery and internal medicine, gynecology and obstetrics, ophthalmology, ear, nose and throat medicine, orthopedics, paediatrics and urology. If a corresponding need is determined, you can also provide the fields of dermatology, oral and maxillofacial surgery, neurology and psychiatry.

III. Care level

Maximum care hospitals must, within the scope of demand, go significantly beyond hospitals with specialty care with their range of services. They should provide the corresponding highly differentiated medical-technical facilities. University hospitals perform tasks of maximum care. They are to be included in the hospital planning, taking into account their research and teaching tasks.

Saxony-Anhalt

In Section 3 of the State Hospital Act (KHG LSA), the state of Saxony-Anhalt also requires levels of care that are defined in joint framework specifications by the state, municipalities, hospital society and associations of statutory and private health insurance according to Section 3 (2) KHG LSA.

There are four levels of care:

  • Basic care
  • Main focus supply
  • Special care
  • University supply

Regulations without levels of care

Most federal states do not divide the hospitals into care levels in their hospital laws.

In the laws of Bremen (Section 4 BremKrhG) and Hamburg (Section 15 HmbKHG), care focuses are named, but these have a different meaning than care levels. In Lower Saxony , the hospitals listed in the hospital plan are classified according to Section 3 (3) Nds KHG according to medical specialties, planned beds and functional units as well as training facilities according to Section 2 No. 1 a KHG .

In North Rhine-Westphalia , according to §§ 12, 16 KHGG NRW, the notification about the inclusion of a hospital in the hospital plan u. a. the supply area, the supply region for compulsory psychiatric care, the total number of planned beds, the type of departments with their number of planned beds and their treatment places as well as the training facilities according to § 2 No. 1a KHG. Similar regulations exist in Baden-Württemberg (Section 6 LKHG), Berlin (Section 4 LKG), Brandenburg (Section 14 LKGBbg), Mecklenburg-Western Pomerania (Section 24 LKHG MV), Saarland (Section 23 SaarKHG), Thuringia (Section 4 ThürKHG) .

In Hesse , with the amendment of the Hospital Act in 2002, the distinction between care levels was effectively abolished (see Section 17 HKHG).

Overview of the number of beds in general hospitals in Germany 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

Keyword supramaximal supply

Various university hospitals claim, for example with regard to coping with a mass seizure of injured and sick people (ManV), to be regarded as a hospital of supra-maximum care . However, this designation does not exist in the hospital requirement plans .

Web links

Individual evidence

  1. ^ Hospital plan of the Free State of Bavaria. (pdf) Free State of Bavaria, January 1, 2018, accessed on October 19, 2019 .
  2. ^ Ministry of Social Affairs, Labor, Health and Demography of the State of Rhineland-Palatinate: State Hospital Plan 2010 ( Memento from May 26, 2015 in the Internet Archive ) (PDF), p. 42f.
  3. ↑ sachsen-anhalt.de: Framework specifications for supply and quality goals of hospital planning in Saxony-Anhalt according to § 3 (2) KHG LSA (PDF; 895 kB), p. 14f.
  4. ↑ Hessian Hospital Act § 17 .
  5. ↑ http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_PROC?_XWD_2/1/XWD_CUBE.DRILL/_XWD_30/D.922/11784