Pricing System in German Hospitals - DRG System
DRG stands for Diagnostics Related Groups; this system which commenced on January 1, 2004 was introduced by the German government as a general pricing system for medical treatment to ensure uniformity in medical service costs in Germany. The DRG is currently obligatory for almost all the acute care hospitals in Germany.
Price regulation specified in the DRG are applicable to all patients. German citizens and Foreign nationals, be they private or self paying may be priced only under the DRG. This statement has been made very clear in the concerned law (SGB 5).
The German DRG system classifies hospitals into about 18 different categories based roughly on the health areas namely, eye disease, respiratory, digestive etc. The particular Diagnostic Related Group or the DRG is defined according to the specific diagnosis, the medical procedures that were performed for the condition, additional diagnoses and some other complications that were discovered. There are over 800 DRG codes each with it’s own unique economic case value. Each hospital also has it’s base value. The DRG code value multiplied by the specific hospital base value gives the bill amount. The base rates are comparatively less for hospitals in the southern part of Germany.
In most German hospitals patients who are not able to claim the treatment based on their social security health plan are treated as private patients. Private patients can either claim the treatment later from their private health insurance company or if are not insured at all will be responsible for therir bills personally and are offered additional options like treatment from the clinical department chairman or the superintendent. In such cases the physician is entitled to individual pay and hence the bill amount may be high and difficult to estimate. The costs of treatment from the medical superintendents are not included in the DRG. In the usual estimate the cost in this situation may vary between 50% and 100% of the hospital costs.
Foreign patients are however not obliged to use this option. They may accept treatment from the hospital medical staff and be treated by well qualified senior physicians whilst avoiding the additional physician bills. The important thing that the patient should know is that no hospital is allowed to manipulate or push the patient into a private treatment agreement by unethical means such as postponing treatments, creating delays in treatments etc.
The DRG catalogue also lists some additional costs for instance the average duration of stay per procedure. As a standard most German hospitals have rooms with three beds. Patients seeking more comfortable single or double room accommodation may do so with an additional charge.
The DRG system offers an effective way to estimate the cost involved for specific treatments in specific hospitals. They are therefore an important means of comparison of services and also a safeguard ensuring quality standards and value for money for the patient. The DRG estimate is an approximation, the exact cost may only be known after the treatment.
Post new comment