Compared to the past, patients spend fewer days in the hospital. The length of stay fell from ten (1998) to 7.3 days on average (2017). The reason: hospitals are no longer paid according to the length of stay of their patients, but according to fixed flat rates per case (DRGs).
The number of stays, on the other hand, is rising: In 2012, hospitals in Germany provided inpatient care to 18.6 million people. In 2017, the figure was already 19.4 million.
Hospital – the definition
The legislator defines a hospital as any facility in which diseases, ailments or physical injuries are diagnosed, cured and/or alleviated by medical and nursing services, obstetrics is provided and in which the patients or persons to be cared for can be accommodated and fed. Hospitals must be under the permanent medical supervision of a physician, have sufficient diagnostic and therapeutic facilities to fulfill their mandate, and work according to scientifically recognized methods.
Trend toward privatization
Since hospitals with public sponsors (currently 30 percent) are often particularly large, most beds (47.8 percent) are located here. Here, too, the trend toward privatization is becoming apparent, and the proportion of beds in private hospitals (currently over 30 percent) is steadily increasing. By contrast, the share of beds in non-profit hospitals is falling (from 34.1 percent in 2012 to 18.7 percent in 2017).
Full- and day-care hospital services provided by hospitals included in the hospital requirement plan of the respective federal state are remunerated in accordance with the Federal Hospital Rate Ordinance or the Hospital Remuneration Act. All public and non-profit hospitals must bill according to these regulations. In the case of private hospitals, on the other hand, there are also hospitals that are not subject to the statutory provisions and are therefore free to set their own prices. This can lead to difficulties in the reimbursement of hospital services by health insurance.
Inpatient versus outpatient
The strict separation between outpatient physicians and clinics of all kinds is to be softened in the future. Integrated care,” which was introduced as part of the 2000 health reform, focuses on overarching forms of care. It promotes greater networking of the various disciplines and sectors (general practitioners, specialists, hospitals). This is intended to improve the quality of care for patients and reduce health care expenditures.
Types of hospitals
There are different types of hospitals in Germany. Thus, a distinction is made between university hospitals, general hospitals, specialist hospitals, affiliated hospitals, practice clinics, and day and night hospitals.
- University hospitals are intended to provide comprehensive inpatient care to the population. Another focus is on medical education and research.
- General hospitals are intended to provide comprehensive inpatient care to the population. There are several medical specialties here.
- Specialty hospitals are specialized in certain fields (e.g. endocrinology, dermatology, ophthalmology).
- In inpatient hospitals, medical services are not provided by employed physicians, but by contract physicians in private practice. The hospital only provides the premises and takes care of accommodation, meals and patient care.
- A day clinic is a facility for outpatient/partial inpatient care. Patients can be treated or cared for here for up to 24 hours. There are more and more surgical day clinics at hospitals – outpatient operations are performed here.
In principle, a patient is free to choose the hospital. However, not all treatments are offered in every hospital. A look at the clinic’s quality report can be helpful here: since 2005, clinics have been required by law to provide information about their structures and services.
Hospitals are classified into different categories depending on their care role. A distinction is made between basic and standard care clinics, regional hospitals with a medium level of care, and hospitals with a focus (e.g. university hospitals) with a maximum level of care. The clinics are usually divided into departments such as internal medicine, surgery, ENT, dermatology or urology. Most hospitals also have intensive care units.
