Performance-oriented hospital financing

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The performance-oriented hospital financing system (LKF system for short) is the Austrian version of a DRG system introduced in 1997 .

Financial flows in the Austrian healthcare system
      Bonuses → Private insurance   Special services    
                             
                        Catalog services ( after DRG )      
        Contributions → Health insurance (
compulsory insurance) 		         
                         
        Taxes FA →                        
          → BM (Fin) countries → BGA          
       
                Art. 15a BV-G   ↓ budget   ←      
Country Fund (
LGF) 		   
                →   →          
             ↓    
population   Deductibles   Fund KA ←                  
     
 AN , AG (←) → ←   fee   ←    
        Private KA                
    some deductibles *   ← PRIKRAF ←      
     
              Expense coverage        
or. (←) → Outpatient clinic ←        
                   
    some deductibles *           Flat rate
+  individual services 		       
  (←) → (practicing)
doctor 		←        
          Exp. f. Drugs
+  of pharmacy services 		 
    Prescription fee **                          
patient (←) → pharmacy ←        
                   
    ↑                        
        reimbursement        

(Fin) Ministry of Finance distributes the budget for the Ministry of Health ;
* flows directly to KV carriers;
** flows via pharmacy to health insurance providers;
(←) partly direct reimbursement or exemption for mandatory verse.
Reds: Government Sector,
Yellows: Private Sector

Diagram according to Ziniel (2005)

description

DRG systems have been in use since the beginning of the 1980s in the USA and more recently in Germany for financing hospitals . With the LKF system in Austria , funds are distributed in around half, i.e. around 140 of the total of 264 Austrian hospitals . In total, the 140 hospitals affected had annual costs of around 8.5 billion euros in 2004, three quarters of them for the inpatient area, 13% for the hospital outpatient departments and the rest for other expenses (such as nursing schools, research centers, etc.).

These 140 so-called state fund-financed hospitals provide around three quarters of the total of around 63,000 hospital beds and care for around 90% of in-patient patients or 2.5 million hospital stays (with almost 15% so-called 0-day cases or used synonymously) 1-day care are included in the inpatient costs, which could also be defined as outpatient treatment). Since 2002, social security funds amounting to around 70 million euros have also been distributed annually to around 45 private hospitals according to the LKF system.

Before the introduction of the LKF system, bills were essentially based on a flat rate per hospital day. This could mean that some hospitals kept patients in hospital longer than medically necessary, provided that beds were of course free and the patients had to be convinced of the need for a longer stay. The LKF system has now brought about a change: the hospital receives a lump sum again, but it is now mainly dependent on the diagnosis and the performance (e.g. surgery , chemotherapy , cardiac catheter examination, etc.) within certain so-called upper and lower limits for covering duration.

For example, the operation of the gallbladder is rated with 3,541 LKF scoring points, regardless of whether the patient had to stay in the hospital for 5 days or 13 days. Only for even shorter or longer stays will surcharges or discounts on a daily basis apply.

In general, the LKF points are to be seen as a comparison value, which, depending on the federal state, but also depending on the hospital, lead to a complicated payment in euros. Often there is a so-called company exit cover, where a financier, usually the public sector, agrees to pay the loss (company exit). The original calculation of the DRG scoring points was based on the size of 1 point = 1 euro, but due to the above-mentioned circumstances, one point can de facto B. only 60 cents are paid because money is given from other areas ("pots") and, conversely, not all funds are brought into the "LKF pot".

Funding-relevant documentation bases for the DRG system are, in addition to some typical patient data such as date of birth, gender, ward, admission and discharge date, above all the diagnoses according to ICD-10 and the services according to an Austria- specific catalog of services . Some special areas such as intensive care units, geriatric areas and others are still included in the financing.

See also

Web links

  1. ↑ Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.