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POLICY: EUROPEAN DEVELOPMENT
adopted this model. In these countries, the regional health
authorities contracts with – usually public – hospitals and
health centres.
In Germany, corresponding elements are being gradually
introduced. There is more freedom for contracts between
individual – public – health insurancs and particular service
providers or even between groups.
As service providers are unable to reverse theis trend
towards the purchasing model, the likely consequence is the
emergence of greater competition between established
physicians and hospitals, between health insurance
companies and between hospitals themselves. They all have
to face the competition and try to get the best out of it for
themselves and their patients.
More competition by integrated supply and
structured treatment programmes
This constant increase in competition has been
accompanied by a further trend in some European
countries, for example in the United Kingdom and Austria,
that is the development of integrated supplying forms and
structured treatment programmes.
The rationale for this is the optimum provision of service
to patients is often obstructed by a lack of cohesion and by
unsatisfactory co-operation of the different service
providers. The resultant outcome is one of failed delivery
service to the individual patient and failings in the health
system. There is therfore on the one hand, expensive
multiple investigations, and on the other hand,
informational deficits and interrupted treatment chains.
In Germany, these problems are significantly pronounced,
one reason being the existence of the policy of strict
separation of various health sectors. For many decades,
politicians have tried to find solutions; usually, they failed
because of a lack of courage and strength of will; the system
thus has remained unhanged, and has instead became even
further entrenched. The law of GSG about the out-patient
surgery in 1993 brought a new hope and perspective. The
new GMG of 2003 could start a significant further
development into that direction.
For the ‘integrated supply’, special financial resources
were founded, which will increase the incentive of health
insurance companies and service companies to offer more
appropriate contracts. However, one must be aware that the
financial resources (additional money) will not be used for
the recent health-system. Any Euro that is spent for the
system will be removed from the service providers budget
before, particularly from the hospitals budget.
More competition by opening hospitals
In the context of current developments, one has to regard
the increasing tendency of hospitals towards the supply of
patients with out-patient treatment.
Once again, we should investigate the German system:
Not because the German system is a representative model,
but because it clearly shows what was going wrong. It has
not been allowed for German hospitals to offer out-patient
treatment to normal patients. With the current health
reform, this will improve in a few matters of detail. The full
supply of the patients will increase, but only in hospitals
that offer appropriate contracts to health insurance
companies or that found new ‘supplying centres’.
These trends are quite important for hospitals. Hospitals
are nearly perfect for any organisation of integrated supply
and integrated production; they also maintain strong
management capacities, experts and interdisciplinary teams,
and at least, they have an advantage in quality assurance
compared to established physicians. Therefore, hospitals
should participate actively in the development of integrated
supplying forms, and they should enlarge the range of their
out-patient treatments.
More competition by defined lump sums for
medical treatments
The transition from daily rates to lump sums with respect to
hospital remuneration has to be judged as an as innovative
as daring contribution to the reinforcement of the
competition thought. A recently published trade-off study
by DKG (German Hospital Association) shows that the DRG
system (medical lump sum system), is becoming more and
more important in the whole of Europe. With exception of
Luxembourg, every country in Europe is using the system of
the DRG, for instance for benchmarking, for quality
assurance, for the calculation or distribution of budgets or,
however, – as in Germany – for remuneration of any
individual case of treatment.
Great Britain decided to change over to a medical lump
sum system until 2008. Obviously, the ‘German system’ was
taken as a model for Great Britain, because the British want
to include all in-patient treatments and obviously intend to
start a country-wide fixed price system for the DRGs.
Besides that, some of the new European countries have
experiences with the DRG system, too. For instance,
Hungary already has used DRGs for more than 10 years,
while Tschechia and Romania have just started to introduce
the lump sums.
Development of quality standards
The pressure to ensure better medical and nursing quality
will continue to increase, although the financial budgets
will remain scarce. A current report by the European
Union Commission shows that this topic is located at the
top of the political agenda in most EU member states. In
the last years, nearly every country achieved progress
regarding the development of quality standards in the health
service. According to the EU report, the in-patient sector
leads the way in this respect. In contrast to that, the outpatient
sector still has substantial implementation problems,
even with regard to questions of structure quality, which
could be measured and improved quite easily.
In contrast to this, there is still a larger pent-up demand
for all supply areas with respect to the quality of process and
result. Hospitals should take the leading role within this
movement, too. The call for public, measurable criteria for a
high-quality achievement becomes louder and louder.
Medical progress that one can afford
16 | World Hospitals and Health Services | Vol. 40 No. 4