Zurück zur Struktur? Zur gegenwärtigen und zukünftigen Gewährleistung stationärer Gesundheitsversorgung
Year: 2021
Author: Deister, Sören
Die Verwaltung, Vol. 54 (2021), Iss. 3 : pp. 341–374
Abstract
The article analyzes regulatory structures in German public health law in the light of the pandemic. It focuses on the responsibility of the welfare state to provide access to hospital treatment. While the public law corporations that finance statutory health insurance, keenly argue in favor of centralization and specialization, others, including the German Hospital Federation, prefer regional planning and highlight the importance of sufficient hospital bed capacity. The German hospital sector is characterized by a mixture of public, private for profit and charity-based hospital owners who provide hospital treatment. The state and independent public law corporations guarantee equal access to healthcare via statutory health insurance. For historic reasons, there is a highly complicated system of “self-administration”, in which representatives of doctors and hospitals are given the power to “regulate themselves” in cooperation with public law health insurance fonds. Non-medical staff, especially nursing staff, is not represented in this system, which explains why their interests tend to be ignored. Additionally, the German Bundesländer (states) have the power to determine hospital capacities, usually understood as bed capacities, via hospital plans. Over the last two decades, the German hospital financing system was fundamentally changed by the introduction of diagnosis related groups (DRGs), potentially causing hospital owners to prioritize profit over patient care. The article examines the legal framework of hospital planning as well as the latest developments in hospital financing and quality assurance and argues against the idea that the health care sector should be shaped by market competition rather than planning.
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Journal Article Details
Publisher Name: Global Science Press
Language: German
DOI: https://doi.org/10.3790/verw.54.3.341
Die Verwaltung, Vol. 54 (2021), Iss. 3 : pp. 341–374
Published online: 2021-07
AMS Subject Headings: Duncker & Humblot
Copyright: COPYRIGHT: © Global Science Press
Pages: 33
Author Details
| Section Title | Page | Action | Price |
|---|---|---|---|
| Sören Deister: Zurück zur Struktur? Zur gegenwärtigen und zukünftigen Gewährleistung stationärer Gesundheitsversorgung | 341 | ||
| I. Einleitung | 341 | ||
| II. Patientenorientierte Gewährleistungsverantwortung | 342 | ||
| 1. Gewährleistungsverantwortung | 342 | ||
| 2. Patientenorientierung | 345 | ||
| 3. Ausdifferenzierung staatlicher Verantwortung | 347 | ||
| III. Krankenhausplanung | 349 | ||
| 1. Ziele | 349 | ||
| 2. Instrumente | 341 | ||
| 3. Entscheidungsprogramm | 341 | ||
| 4. Zusammenfassende Einordnung | 341 | ||
| 5. Steuerungsdefizite | 341 | ||
| IV. Zentrale Entwicklungstendenzen | 341 | ||
| 1. Ökonomisierung durch DRG-Vergütung | 341 | ||
| 2. Qualitätsorientierte Versorgungssteuerung | 342 | ||
| V. Coronabedingte Maßnahmen | 342 | ||
| 1. Maßnahmen zur Kapazitätserhöhung | 342 | ||
| 2. Steuerungsdefizite | 343 | ||
| VI. Zusammenfassende Schlussfolgerungen | 343 | ||
| 1. Bedarfsplanung statt Strukturbereinigung durch Ökonomisierung | 343 | ||
| 2. Auskömmliche Strukturfinanzierung statt überkomplexer Detailsteuerung | 343 | ||
| 3. Stärkung kommunaler Krankenhausversorgung | 343 | ||
| 4. Offene Fragen: organisations- und verfahrensrechtliche Ausgestaltung | 343 | ||
| Abstract | 343 |