On the interdependence of ambulatory and hospital care in the German health system

Abstract

For some considerable time now the interface between ambulatory and hospital care has been mooted as a cause of inefficiencies in the German health system and there have been calls for a softening of the strict separation between the two sectors. This debate emphasizes the need for detailed empirical information on the interdependence between the two sectors. Using extensive administrative data at the level of the 412 German counties for the years 2007 to 2009 and a simultaneous equation model which allows the numbers of ambulatory and hospital cases to be mutually interdependent, we examine the connection between ambulatory and hospital specialist care separately for ten medical specialties. The results show that the interdependence of ambulatory and hospital services is far from homogeneous. The relationship depends, on the one hand, on the specialty and, on the other, on the direction of the effect observed. This heterogeneity needs to be taken into account for cross-sector needs-based planning.

Procedures performed by general practitioners and general internal medicine physicians - a comparison based on routine data from Northern Germany

“…This is in line with findings of previous studies, that GPs place more emphasis on preventive services [ 7 , 12 ]. Recent studies highlight the positive effects of preventive care on the reduction of hospital admissions and emergency department visits [ 50 – 52 ]. In Germany, the increasing number of non-urgent emergency department visits has resulted in overstretched emergency facilities with negative effects on quality and effectiveness of the emergency care provision [ 53 – 55 ].…”

Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach

“…The exchange of information is particularly susceptible if a patient is discharged from hospital. With regard to the strongly pronounced sectoral separation in Germany [ 10 , 11 ], information loss is particularly high between inpatient and outpatient care. Moreover, owing to the accelerated tendency toward shortening the length of stay of patients in the inpatient sector as a result of the introduction of the diagnosis-related group–based reimbursement system [ 12 ], hospitals no longer provide care and treatment until full recovery [ 13 ].…”