Leistungsverlagerungen zwischen Krankenhäusern und niedergelassenen Ärzten - Ein Beitrag zur Methodik der Messung von Verlagerungseffekten und grobe Abschätzung der Bedeutung

Abstract

The criteria for patient shifting as defined above apply to 26 out of 95 risk groups. At the level of risk groups hardly any patient shifting into ambulatory care was detected. On average for each patient with the respective risk factors 0.6 additional cases in ambulatory care were estimated as result of reduced incidence of inpatient care. In total the additional cost associated with patient shifting from inpatient care to ambulatory care was estimated 424 million € (2007). This represents 1.5% of total spending on ambulatory care and underlines the importance of the issue to health services research. Roughly 80% of this amount is likely to be eligible to physician services relevant to morbidity adjusted targets under payment reform. Prior to implementation as a payment formula, however, the approach needs to be based on a comprehensive risk adjustment model and needs further refinement.

Overutilization of ambulatory medical care in the elderly German population? – An empirical study based on national insurance claims data and a review of foreign studies

“…Therefore, questions arise about the relationship between benefit and harm of such high contact rates. As the utilization of inpatient care in Germany is also at the top of the OECD ranking list [ 18 ], more research is needed on the reasons and motivations for utilization rates in both healthcare sectors as well as on the interaction between the two [ 52 ]. In contrast, older people generally need a comprehensive and coordinated treatment plan, which is difficult to achieve with a two-digit number of contacts with specialists, especially considering the well-known deficits of communication between these specialists [ 53 ].…”