External quality assurance for hospitals

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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

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

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Providers

• Payers

• Patients, Consumers

• Political Parties

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

Government
MoH	very supportive		strongly opposed
Providers
Hospitals	very supportive		strongly opposed
Payers
Sickness Funds	very supportive		strongly opposed
Patients, Consumers
Patients representatives	very supportive		strongly opposed
Political Parties
CDU/CSU	very supportive		strongly opposed

Actors and influence

Government
MoH	very strong		none
Providers
Hospitals	very strong		none
Payers
Sickness Funds	very strong		none
Patients, Consumers
Patients representatives	very strong		none
Political Parties
CDU/CSU	very strong		none

Positions and Influences at a glance

Expected outcome

References

Author/s and/or contributors to this survey

Sebastian Hesse, Susanne Weinbrenner, Sophia Schlette

Suggested citation for this online article

Sebastian Hesse, Susanne Weinbrenner, Sophia Schlette. "External quality assurance for hospitals". Health Policy Monitor, 12/04. Available at http://www.hpm.org/survey/de/b4/1