Investitionspauschalen als Weg in die Monistik?
In Germany, operating costs of hospitals are financed by the patients or their health insurance funds, respectively, while investment costs are borne by the federal states – often by granting subsidies to larger investment projects. This so-called dualistic financing is faced with two fundamental problems: First, there is a substantial annual underfunding of investments, cumulating to an estimated 12 billion Euro. Second, it produces an inefficient allocation of capital, which is supported by empirical studies. The latter problem could be solved by switching to monistic financing, i.e. patients or their health care funds pay for all hospital costs which is, however, practically impossible. An investment lump-sum based on DRGs would be an equally effective alternative. From 2012 on there will be a fully elaborated system of investment lump-sums, embedded into the DRG system, which the federal states can optionally choose to implement. For efficiency reasons, they should be advised to do so. In the long run, a further step towards monistic financing is possible. If at least all 16 federal states transferred the investment volume of the state with the lowest subsidy per case to the health insurance funds – ideally after abolishment of the GKV-PKV-dualism – around three quarters of the investment lump-sum could be directly financed by the health insurance funds.
Augurzky, B. (2011), Investitionspauschalen als Weg in die Monistik?. In Jürgen Klauber, Max Geraedts, Jörg Friedrich and Jürgen Wasem (Hrsg.), Krankenhaus-Report 2011 - Schwerpunkt: Qualität durch Wettbewerb. Stuttgart: Schattauer, 161-172.