Maintenance rate
A care rate is the remuneration that users of a partially or fully inpatient facility or the cost bearers of the user have to pay for certain services of the facility. If the amount of the care rate does not vary depending on the length of stay, the severity of the case or other criteria, one speaks of a daily care rate . The amount of the care rates is usually agreed between the social service providers and the providers of the care facilities according to certain legal requirements.
In hospitals, the nursing care rate covers all costs; in nursing homes, it does not include the costs for accommodation, meals and investment costs .
Nursing homes
In nursing homes , nursing care rates are the remuneration of the residents or their payers for the partial or full inpatient care services of the nursing home as well as for social care and, if there is no priority claim to nursing according to Section 37 SGB V, for medical treatment care . The care rates cover all of the care services required by the care facility (general care services) for the care of those in need of care according to the type and severity of their care needs.
The composition of the nursing care rates and the nursing rate procedure are regulated in particular in § 84 , § 85 , § 86 SGB XI.
According to this, the type, amount and duration of the nursing care rates must be agreed between the provider of the nursing home and the nursing care funds as well as the social assistance providers (service providers). A separate care rate agreement is concluded for each approved nursing home.
The amount of the care rates is based on the care expenditure that the person in need of care needs according to the type and severity of their need for care ; it is divided into three care classes analogous to the three care levels of care insurance . In addition, surcharges for people in need of care who are recognized as hardship cases can be agreed in addition to the care rate for care class 3
The average monthly care rates (care costs) in Germany in 2011 were:
for care level I - 1,369 euros
for care level II - 1,811 euros and
for care level III - € 2,278.
The long-term care insurance only pays lump-sum and limited amounts exclusively for the care costs in the home (for the care expenses, medical treatment care and social care) (partial benefit insurance), which does not cover the actual costs.
In 2011, these insurance benefits (for care costs)
for care level I at - 1 023 euros
for care level II at - 1 279 euros and
for care level III at - 1,510 euros.
Due to the completely lacking and then completely inadequate performance dynamization from 1995 to 2008, the costs that had to be raised by the person in need of care or their close relatives (children) or by the social welfare office / war victims' welfare (in this order) for care continued to rise (In this way a “creeping privatization” was carried out).
In 2011, the average own contribution to the care costs was
for care level I - 346 euros
for care level II - 532 euros and
for care level III - 768 euros.
The care rate does not include the costs for accommodation and meals (so-called "hotel costs") as well as the investment costs to be borne by the person in need of care. Only by adding the care rate + costs for accommodation and Food + investment costs you get the total costs for the stay in a nursing home.
hospital
Until 1974, the maintenance rates were still based on the old price law. On April 25, 1973 the first Federal Care Rate Ordinance (BPflV) was passed, which came into force on January 1, 1974. Each hospital charged individual general care rates without differentiating between departments. Section 17 (1) of the Federal Care Rate Ordinance provided for profit or loss compensation for the past care rate period ( cost recovery principle ) (cost recovery principle ). In the implementation, however, there was no guarantee for the hospital that it would actually get its own costs back in full, since only the necessary and economic cost factors were taken into account. Hospital costs continued to rise as a result of steadily growing medical advances, an increase in the number of cases and rising prices even after the introduction of the KHG and the BPflV.
The level of the care rate is agreed in annual budget negotiations between the individual hospital and the cost bearers ( health insurance companies ). The nursing care rate is paid for each treatment day of inpatient treatment (billing days) of a patient. The nursing care rates of different hospital operators differed not only in their absolute amount, but also in the intensity of the increase in nursing rates. The level of the nursing care rate was crucially dependent on the length of stay and the use of the beds (degree of occupancy) in the hospital.
On August 21, 1985, a new Federal Care Rate Ordinance (BPflV) ( Federal Law Gazette I p. 1666 ) was issued, which came into force on January 1, 1986. The Hospital Financing Act (KHG) was revised on December 23, 1985 ( Federal Law Gazette 1986 I p. 33 ). For the first time, a flexible budget was introduced to secure fixed costs, with daily care rates as down payments and the admission of profits and losses. An intention to make a profit , also through rationalization measures , was allowed. With revenues deviations from the preliminary costing the budget could be adjusted or a revenue compensation be decided in a care rate negotiations. According to Section 4 (1) of the Federal Care Rate Ordinance of 1986, variable costs were assumed to be 25% and fixed costs to be 75%.
With the third revision of the Federal Care Rate Ordinance (BPflV) of September 26, 1994, which came into force on January 1, 1995, the care rates were no longer based on the cost recovery principle that was valid until December 31, 1992, but instead flat-rate per case and special remuneration were new Forms of payment introduced. Flat rate per case for certain treatment cases, special fees for certain operations. As well as an individual hospital budget, which was settled with the help of department and basic nursing rates (fees for medical and nursing activities). With the Stabilization Act of April 29, 1996 ( Federal Law Gazette I p. 654 ) and other laws, the budget cap was continued. Distinction:
- Basic care rate calculation: per day of inpatient treatment (day of discharge may not be calculated in principle), which covers the costs of accommodation and meals and is uniformly defined for a hospital.
- Departmental care rate calculation: per day of inpatient treatment for medical and nursing services. The departmental care rate is an average care rate, limited to the cases of one department, e.g. B. Urology or Orthopedics.
As of 2005, the same-day care rate will only be used in hospitals for psychiatric departments. From 2003 onwards it was gradually replaced by a system of flat rates per case ( DRG ), see also German Diagnosis Related Groups (G-DRG).
See also
swell
- ↑ Section 84 (1) sentence SGB XI
- ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ SGB XI - § 43 (content of the service)
- ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ buzer.de: Act on the structural development of long-term care insurance (Long-term Care Further Development Act - PfWG of May 28, 2008) - s. here § 30 SGB XI
- ^ Sozialverband Deutschland: Statement on the 2008 long-term care reform - s. in particular Section II, 2.
- ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 51–53 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 12 + 122 / table 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
