REVIEW, ANALYSIS AND EVALUATION OF THE LA W ON REFORM OF THE HEALTH-CARE SYSTEM AND THE 1995 STATUTORY RATES OF CHARGES FROM THE ANGLE OF THE TRAUMA SURGERY DEPARTMENT OF A UNIVERSITY HOSPITAL - PREPARING FOR THE NEW SYSTEMS OF REIMBURSEMENT AND REGULATIONS ON DOCUMENTATION

Ail doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of t he hospitals to limit the negative consequences to the patients. It wo uld be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the ch arges. The revision of the health system is beneficial in that it supp orts the economical independence of hospital departments. It is a good idea for them to be paid by results; however, there are no establishe d methods of measuring results or efficacy in medicine. Germany is abo ut 10 years behind the USA in this, so that our country is not yet rea dy for this reform. Hospital departments do have the freedom to make e conomic decisions, being heavily dependent on the insurances and the g overnment, because most people who work in hospital are paid from thes e sources. Departments of trauma or orthopaedic surgery are disadvanta ged by the reform, because of the number and kind of diagnosis related groups and the method of reimbursement. This leads to a profit-orient ed system of medical documentation, with possible upcoding of diagnose s in future. The present health reform most probably will not increase the efficiency of hospitals; it will not be possible to attain cost r eductions with the same level of medical care. The reduced reimburseme nt will force doctors to cut down their expenses and restrict diagnost ic and therapeutic procedures. On the other hand the administration se ctor in hospitals and insurances will expand dramatically in future. T his health system revision will change a relatively simple system of h ospital reimbursement (charge to patient per year/days of nursing per year = reimbursement per day) to a very complex model with a mixture o f diagnosis-related groups, payments for special procedures, basic and special reimbursements for nursing. In the end, the patients insured with health insurances will receive a lower level of medical care but with increasing administrative costs. When will these administrative c osts of health insurances be budgeted for? And the last and most impor tant questions remains: What are we willing to pay for out health?