Operations surge dramatically

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Number of operations increased significantly - economic reasons decisive?

The number of operations in German clinics increased by around 25 percent between 2005 and 2011. This emerges from the Federal Government's response to a question from the Bundestag faction “Die Linke”. The number of operations performed has increased from around 12.1 million in 2005 to 15.3 million in 2011. According to the left, false incentives in the system mean that operations are increasingly carried out not because of medical necessity, but because of the remuneration.

With the introduction of the flat rate per case (Diagnosis Related Groups - DRG) in hospitals since 2005, the "services of the hospitals were no longer paid according to length of stay, but rather according to diagnosis", explains "Die Linke" in a preliminary remark to the answer of the Federal Government. In contrast to all other countries, the DRG in Germany would be used as a pure price system. “As the fees for the services provided have risen more slowly than costs in recent years, a vicious cycle has started. Hospitals can only survive if they increase the number of cases, “Die Linke continues. This means that either more patients have to be treated or the invasiveness of the treatment has to be expanded - for example through more operations or other procedures. A thesis that is supported by the numbers in the Federal Government's answer. The 25 percent increase in operations cannot be explained by demographic change alone.

Bad incentives in the health system
In its preliminary remark, the Federal Government also indirectly admits that there are or have been false incentives in the health system by declaring that "first measures to reduce incentives for non-medically indicated service provision have already been initiated". In fact, the drastic increase in operations since the introduction of the flat rate per case seems to give the government parties some reason to think. It is hardly surprising, especially since the number of interventions in individual areas, such as spinal surgery, has more than doubled - from around 327,000 operations in 2005 to around 735,000 operations in 2011. In addition, the international comparison shows in the response of Federal government that significantly more hip, knee and caesarean sections are performed in Germany than in other European countries. Overall, the willingness to undergo surgery seems to have increased significantly in this country.

Operations for economic reasons?
It is not clear from the Federal Government's answer whether the increased willingness to operate in German clinics is due to false incentives or the flat rate per case, but there is reason to suspect. In the opinion of the left, the well-being of patients is no longer the primary focus, but economic criteria are becoming more important. “Time-consuming nursing or medical treatments or benefits are cost-effective and are reduced for economic - not medical - reasons. The quality of care suffers as a result, ”concludes the left.

The health spokesman for the CDU parliamentary group, Jens Spahn, told the news agency "dpa" that there is no doubt that there is more surgery in Germany than in other European countries. However, Spahn did not provide a possible reason, but referred to a study that should clarify this question by the end of the year. Every patient must be able to rely on the fact that only medically necessary operations are carried out and not operated in order to increase sales, Spahn continues. A statement that politicians of all parties can sign. However, the question is in what form this approach is also taken into account in political decisions. If economic efficiency in the healthcare system becomes the maxim of action, corresponding problems are inevitable. The clinics and doctors will always keep the cost-benefit factor in mind, which leads to disadvantages for the patients when in doubt. (fp)

Photo credit: Thommy Weiss / pixelio.de

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