THE NEW GERMAN HEALTH-CARE LAW - EXPERIEN CES WITH CASE RELATED PAYMENT IN SURGERY

According to new German health care laws (Gesundheitsstrukturgesetz, B undespflegesatzverordnung) hospital payment will be given a new basis. Abandoning the ''length of stay'' - related compensation in the futur e surgical services should be refunded either by special payments for a given surgical prodecure (covering anesthesia, surgery, instruments) , or by case-related payments (including all costs of stay, medical as well as room-and-care and administrative). This should lead to a more equitable payment getting a transparent insight into the relation ser vice/cost. Calculations for the so far 103 special payment and 40 case related payment items have been obtained by a nation wide analysis in reference hospitals. Besides numerous problems introducing these new refund systems in very different hopsital structures, our own 3-year e xperience using case related payment on our surgical department (based on individual calculation) shows promising results. The main intentio n still has to be - by setting free economic resources - to avoid rati oning though rationalization.