Managing Hospital Volumes: Germany and Experiences from OECD International locations



To assist inform the Conference on Managing Hospital Volumes, co-organised by the German Federal Ministry of Well being and the OECD, and held on the eleventh April 2013 in Berlin, the OECD Secretariat produced a paper to supply a global perspective on Germany’s scenario and the present coverage debate. The paper begins by evaluating the construction of the hospital sector in Germany and its stage of volumes with different OECD nations. It then gives a basic background on how hospitals are financed in Germany. Lastly, it gives some observations on the operation of the German hospital system from a global perspective, with a view to highlighting potential areas of debate for coverage makers.

Many OECD nations are presently grappling with the problem of will increase in hospital volumes. Addressing this requires coverage makers to cope with the query of what represents a ‘medically applicable’ quantity of care. That is troublesome to reply, and is more likely to range throughout nations which have totally different social preferences and infrequently considerably totally different well being care programs. Nonetheless, Germany’s stage of hospital companies has historically been larger than many OECD nations by a magnitude far higher than variations in age, morbidity and social preferences for accessing care throughout nations might justify. Compounding this case is a excessive stage of variation within the quantity of companies delivered throughout Germany’s Länder (states), elevating the query of the extent to which this drawback is pushed by elements particular to the well being system.

Whereas the German well being care system could have the monetary capability (and urge for food) to proceed to underwrite a really obtainable hospital sector, the continuous development of hospital volumes from already excessive ranges dangers entrenching incentives for the over-provision and over-supply of hospital companies. This example should focus dialogue and lift questions on whether or not excessive volumes of hospital companies in Germany – each lately and typically phrases – are medically applicable. To assist assist this dialogue, this paper gives numerous observations concerning the construction and financing of hospitals in Germany. After offering an summary to the hospital sector and illustrating that Germany has higher volumes of hospital companies when in comparison with different OECD nations, it argues that:

  • Germany has a extra open-ended method to the financing of hospital companies and weaker controls over the hospital price range than in lots of different OECD nations.
  • DRGs in Germany are virtually strictly used for pricing, whereas different nations use DRGs as one among many instruments they need to affect hospital budgets.
  • State governments don’t have an incentive to rationalise hospital capability the place this can be fascinating. 
  • The huge array of high quality info obtainable in Germany ought for use to raised direct financing.


Following the convention, the paper is now obtainable as a Working Paper: No. 64 – Managing Hospital Volumes: Germany and Experiences from OECD Countries (October 2013). 

Download Hospital Volumes: An International Perspective on Germany: a presentation by Mark Pearson throughout the BMG-OECD Convention on Managing Hospital Volumes, Berlin, April 2013.

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