Financing hospital innovations in Germany

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1 Financing hospital innovations in Germany Marc Schreiner German Hospital Federation

2 German Hospital Federation Representative organ of all German hospitals, no mandatory membership 28 member organisations (16 hospital federations on state level, 12 association on the federal level for each special type of ownership, e.g. different churches, universities, municipalities and counties, private for profit companies, pension funds, etc.) Partner of politics on national, European and international level Key player in the self-government-system of the German health care sector (e.g. in the Federal Joint Committee) Development of the German DRG-System Provision of services to member organisations

3 Key facts German hospital system hospitals (three types of ownership: public, charity based, private for profit), almost beds 1,2 million employees ( full time equivalents) doctors, nurses 18,8 million inpatient services, 20 million ambulatory services Income of 90 billion Euro annually (DRG-based financing system for the costs of the treatment, paid for by statutory and private health insurance funds; grants by states for the costs of investment and contributions by patients) All German hospitals have to deliver their services under the same conditions (legal framework, quality standards, working conditions, reimbursement system, etc.) The patient has the free choice and access to all hospitals

4 Hospitals On the same legal basis Same quality standards Reimbursement under the same conditions Open to all patients Same working conditions Same admission standards

5 Index (2000 = 100) Index (Year 2000 = 100) Hospitals by ownership 140 (3) public charity based private acute care hospitals hospitals public (1) charity based (2) private (3) beds (2) (1) 2) ( (1) (3) beds in ,5 223,6 223,4 221,5 167,9 165,7 164,3 163,1 71,0 73,9 74,7 76, ,9 161,6 78, ,0 160,2 78, ,5 159,2 78,9 Dezember 2015 Source: Federal Statistics Agency

6 Index (Year 1991 = 100) Key facts summary summary: development course key data of german hospitals (2) (3) (6) (1) (5) (4) beds (1) number of cases (2) occupancy rate (3) lenght of stay [days] (4) occupancy days (5) hospitals (6) Dezember 2015 Source: Federal Statistics Agency

7 Hospitals in the region Concentration of hospitals

8 Index (Year 2000 = 100) SHI Companies Expenses hospitals physicians dentists pharma bil. EUR bil. EUR bil. EUR bil. EUR allocation (2014) and development of SHI-expenses others 23,7% pharma 17,2% ,31 23,33 8,03 23, ,17 21,86 7,59 21, ,53 21,95 7,50 24, ,93 22,69 7,67 25, ,42 23,55 7,85 27, ,14 24,65 8,01 28, ,42 26,39 8,19 30, ,13 27,09 8,30 30, ,95 27,63 8,47 28, ,66 28,25 8,67 29, ,19 31,43 9,51 30, ,86 33,43 9,83 33, dentist 6,9% physicians 16,4% 2014 hospitals 35,0% (1) (4) (2) (3) inpatient treatment (1) physicians (2) dental (3) pharmaceutical (4) Dezember 2015 Source: BMG

9 Index (Year 2000 = 100) PHI Funds Expenses hospitals physicians dentists pharma bil. EUR bil. EUR bil. EUR bil. EUR ,7 3,2 1,9 1,3 allocation and development of PHI - expenses ,8 3,4 2,0 1, ,8 3,6 2,1 1, ,9 3,8 2,2 1, ,0 4,1 2,3 1, ,2 4,3 2,4 1, ,4 4,5 2,5 1, ,6 4,8 2,7 2, ,8 5,1 2,9 2, (3) (4) (2) (1) ,1 5,3 3,0 2, ,4 5,5 3,2 2, ,7 5,6 3,4 2, ,7 5,7 3,6 2, ,0 7,1 5,9 6,0 3,7 3,7 2,6 2, inpatient treatment (1) dental (3) physicians (2) pharmaceutical (4) Source: private health insurances federation

10 BW BY BE BB HB HH HE MV Ni NRW RP SL SN ST SH TH Euro Subsidies granted by states State Baden-Württemberg (BW) Bayern (BY) Berlin (BE) Brandenburg (BB) Bremen (HB) Hamburg (HH) Hessen (HE) Mecklenburg-Vorpommern (MV) Niedersachsen (Ni) Nordrhein- Westfalen (NRW) Rheinland- Pfalz (RP) Saarland (SL) Sachsen (SN) Sachsen-Anhalt (ST) Schleswig- Holstein (SH) Thüringen (TH) Total subsidies Mio. Euro % 410,0 14,73 500,0 17,97 106,5 3,83 104,8 3,77 38,6 1,39 137,5 4,94 241,5 8,86 55,8 2,01 258,9 9, ,3 17,69 119,8 4,30 28,6 1, ,0 3, ,9 1,72 90,1 3,24 50,0 1,80 development of the subsidies (1991 = 100) Dezember ,2 100,0 Source: survey conducted by the hospital working group of the states health authorities

11 DRG-System DRG Diagnosis Related Groups (Fallpauschalen) Introduced by 2004 as an opt-in, now it is mandatory One flat fee for the whole treatment From the admission till the discharge of the patient All costs are covered The system is developed continuously

12 DRG-System DRG Diagnosis Related Groups (Fallpauschalen) To each case a single DRG is allotted. In 2015 there were about DRGs existing. Beside the partition into a major diagnosis and sub-diagnosis the length of stay and the complexity factor can be accounted for. With using a so called Grouper -software a specific case-related relative cost-weight can be calculated. Finally the cost-weight is multiplied with the respective state base-rate. Excursion added fees: European Reference Networks

13 Funding of innovations Innovations are taken into account systematically Operational codes and classifications are permanently amended Finally the relative weights are adjusted, if the innovation is accepted to be included Problem: about 3 years for calculation and acceptance NUB Only on application by the hospital in the course of a strictly regulated procedure and acceptance be InEK Only for one year Has to be negotiated on the local level

14 Funding of innovations cases Drugs and medical devices, e.g.: Treated stents with bio-active surface Co-growing heart valve Drug releasing, completely reabsorbing coronary stent In 2014: 115 Million Euro

15 Further innovations New funds on research on innovation 300 Million Euro annually from 2016 to 2019 New models of providing healthcare (225 Million Euro) Provision of care in rural areas Providing care by means of e-health and telemedicine Health services research (75 Million Euro) Fostering quality and patient safety Improving economic efficiency in the healthcare system

16 Investments in German health economics

17 Thanks and contacts German Hospital Federation Director EU-Policies/International Affairs Wegelystraße Berlin Phone: +49 (0) Fax: +49 (0) Mail: m.schreiner@dkgev.de Internet:

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