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External quality assurance for hospitals

Country: 
Deutschland
Partner Institute: 
Bertelsmann Stiftung, Gütersloh
Survey no: 
(4)2004
Author(s): 
Sebastian Hesse, Susanne Weinbrenner, Sophia Schlette
Health Policy Issues: 
Qualitätsverbesserung
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein ja nein nein
Featured in half-yearly report: Health Policy Developments Issue 4

Abstract

In November 2004 the Federal Office for Quality Assurance (BQS) issued its Quality Report 2003, a report on external quality assurance that published full and specific outcome data for all German hospitals authorized to take part in public health care. This report, the first of its kind in any country, presents the assessment of 33 defined surgical and diagnostic measures against quality indicators for medical and nursing procedures.

Purpose of health policy or idea

Purpose of this quality management initiative is to increase transparancy and quality of processes in hospitals in the German health care system.

Quality assessment was already required under the 1989 Health Care Reform Act. But reports by experts, such as the 2000 Report of the Advisory Council for Concerted Action in Health Care, still described severe shortcomings in quality assurance. The Reform Act of 2000, the Case Fees Amendment Act of 2002 and the SHI Modernization Act of 2004 introduced further measures. In 2004 responsibility for quality assurance moved to the Federal Joint Committee, the highest decision-making board in the German self-governing health care system. This move underscores the growing importance of quality assurance in hospitals in recent years.

Quality assurance for hospitals in Germany now rests on several pillars:

  • The obligation to provide internal quality assurance and quality management.
  • Definition of a minimal volume for specific procedures such as liver transplantation; minimal volume must be met as a precondition for reimbursement.
  • Requirement to provide data for the report on external quality assurance published annually by the Federal Office for Quality Assurance. Hospitals showing poor performance will face intensive dialogue including advice and support or even visitation by experts.
  • Quality reports to be compiled by every individual hospital and published on the Internet by the sickness funds every two years. These reports comprise two parts: data on structural characteristics and services provided and description of the quality policy, the external quality assurance and the quality management of the respective hospital. Hospitals failing to prepare the first report (due 31 August 2005) will be visited by the SHI Medical Review Board every year.
  • Finally, the appraisal of hospital procedures on the basis of scientific evidence is the prerequisite for reimbursement by the sickness funds.

Main points

Main objectives

  • Increase transparancy
  • Increase comparability between hospitals
  • Increase quality

Type of incentives

Financial: The appraisal of hospital procedures on the basis of scientific evidence is the prerequisite for reimbursement by the sickness funds.

Non-financial: From 2005 on, hospitals may also use the data generated through the BQS to externally demonstrate their capacity in their structured quality reports. Thus the information can be used as a marketing tool in the competition between hospitals.

Groups affected

Hospitals (administration, physicians, nurses), Patients, Sickness Funds

 Suchhilfe

Characteristics of this policy

Political and economic background

Quality assurance in hospitals has been on the agenda for quite a while in Germany. Since 2001 the BQS leads and coordinates the external comparative quality assurance in German hospitals based on Paragraph 137 Social Code Book V. This was done under the governance of the Federal Board of Trustees for Quality Assurance (Bundeskuratorium Qualitätssicherung).
With  the Statutory Health Insurance Modernization Act 2004 responsibility for the external quality assurance moved to the Federal Joint Committee (Gemeinsamer Bundesausschuß) the highest decision making board in the German self-governing health care system.This move underscores the importance quality issues and the quality assurance in hospitals gained in recent years. In addition to the Institute for Quality and Efficiency in Health Care (IQWiG) the BQS is another pillar of quality management under the responsibility of the Federal Joint Committee.
Together with this external quality assurance for hospitals compulsory quality management for ambulatory care was installed. This is part of an overall strategy to foster quality assurance in the German health care system as a whole. This was part of a strategy the Federal government had on its agenda since the beginning of this legislative periode in 2002.

 

Complies with

Overall strategy to increase quality in the German health care system- hospitals and ambulatory care

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein ja nein nein

Initiators of idea/main actors

  • Regierung
  • Leistungserbringer
  • Kostenträger
  • Patienten, Verbraucher
  • Politische Parteien

Approach of idea

The approach of the idea is described as:
amended: External quality assurance in hospitals already established since 2001

Stakeholder positions

External quality management in hospitals was already established before the Health Insurance Modernization Act 2004. The move of responsibilities to the Federal Joint Committee was crucial to strengthen the role of external quality management in the German health care system.

Actors and positions

Description of actors and their positions
Regierung
MoHsehr unterstützendsehr unterstützend stark dagegen
Leistungserbringer
Hospitalssehr unterstützendneutral stark dagegen
Kostenträger
Sickness Fundssehr unterstützendunterstützend stark dagegen
Patienten, Verbraucher
Patients representativessehr unterstützendunterstützend stark dagegen
Politische Parteien
CDU/CSUsehr unterstützendunterstützend stark dagegen

Actors and influence

Description of actors and their influence

Regierung
MoHsehr großsehr groß kein
Leistungserbringer
Hospitalssehr großgroß kein
Kostenträger
Sickness Fundssehr großgroß kein
Patienten, Verbraucher
Patients representativessehr großgering kein
Politische Parteien
CDU/CSUsehr großgroß kein
MoHPatients representativesSickness Funds, CDU/CSUHospitals

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Expected outcome

References

Author/s and/or contributors to this survey

Sebastian Hesse, Susanne Weinbrenner, Sophia Schlette

Empfohlene Zitierweise für diesen Online-Artikel:

Sebastian Hesse, Susanne Weinbrenner, Sophia Schlette. "External quality assurance for hospitals". Health Policy Monitor, 12/04. Available at http://www.hpm.org/survey/ger/a4/1